贫血是慢性心力衰竭患者预后不良的独立预测因素。

Anaemia is an independent predictor of poor outcome in patients with chronic heart failure.

作者信息

Szachniewicz J, Petruk-Kowalczyk J, Majda J, Kaczmarek A, Reczuch K, Kalra P R, Piepoli M F, Anker S D, Banasiak W, Ponikowski P

机构信息

Department of Cardiology, Military Hospital, ul Weigla 5, 50-891 Wroclaw, Poland.

出版信息

Int J Cardiol. 2003 Aug;90(2-3):303-8. doi: 10.1016/s0167-5273(02)00574-0.

DOI:10.1016/s0167-5273(02)00574-0

PMID:12957766

Abstract

BACKGROUND

Mild anaemia frequently occurs in patients with chronic heart failure (CHF), particularly in the advanced stages of the disease. The correction of anaemia with erythropoietin is a therapeutic possibility. The aim of this study was to assess prospectively the relationship between the prevalence of anaemia (haemoglobin level<or=120 g/l) and prognosis in an unselected CHF population.

METHODS

All consecutive patients with a diagnosis of CHF admitted to our department between January 2000 and April 2000 were considered for the present study. Those with secondary causes of anaemia were excluded. Patients were followed up until November 2001 (>18 months in all survivors), and the end-point of the study was all-cause mortality.

RESULTS

A total of 176 patients were enrolled (mean age: 63 years, New York Heart Association (NYHA) classification I/II/III/IV: 15/81/51/29; left ventricular ejection fraction (LVEF): 42%, ischaemic aetiology in 62%). In the whole population the mean haemoglobin level was 140+/-15 g/l. Anaemia was found in 18 (10%) patients, and was significantly more common in women than in men (18 vs. 7%, respectively, P=0.02) and in those with most severe CHF symptoms (frequency in NYHA I/II/III/IV: 0/9/10/21%, respectively; NYHA IV vs. I-III, P=0.03), but not related to the other clinical indices. Univariate analysis revealed NYHA class III-IV (hazard ratio 3.8, 95% CI: 1.6-8.9, P=0.003), low LVEF <35% (hazard ratio 2.3, 95% CI: 1.0-4.9, P=0.04) and anaemia (hazard ratio 2.9, 95% CI: 1.2-7.2, P=0.02) as predictors of 18-month mortality. In multivariate analysis, anaemia remained an independent predictor of death when adjusted for NYHA class and LVEF (hazard ratio: 2.6, 95% CI: 1.0-6.5, P=0.04). In anaemic patients, 18-month survival was 67% (95% CI: 45-89%) compared to 87% (81-92%) in patients with a normal haemoglobin level (P=0.016).

CONCLUSIONS

Mild anaemia is a significant and independent predictor of poor outcome in unselected patients with CHF. Correction of low haemoglobin level may become an interesting therapeutic option for CHF patients.

摘要

背景

轻度贫血在慢性心力衰竭（CHF）患者中经常出现，尤其是在疾病的晚期阶段。使用促红细胞生成素纠正贫血是一种治疗可能性。本研究的目的是前瞻性评估未选择的CHF人群中贫血患病率（血红蛋白水平≤120 g/l）与预后之间的关系。

方法

本研究纳入了2000年1月至2000年4月期间连续入住我科的所有诊断为CHF的患者。排除有贫血继发原因的患者。对患者进行随访直至2001年11月（所有幸存者均超过18个月），研究的终点是全因死亡率。

结果

共纳入176例患者（平均年龄：63岁，纽约心脏协会（NYHA）分级I/II/III/IV：15/81/51/29；左心室射血分数（LVEF）：42%，缺血性病因占62%）。在整个人群中，平均血红蛋白水平为140±15 g/l。18例（10%）患者存在贫血，女性比男性更常见（分别为18%和7%，P = 0.02），且在CHF症状最严重的患者中更常见（NYHA I/II/III/IV级的频率分别为0/9/10/21%；NYHA IV级与I - III级相比，P = 0.03），但与其他临床指标无关。单因素分析显示NYHA III - IV级（风险比3.8，95%置信区间：1.6 - 8.9，P = 0.003）、低LVEF<35%（风险比2.3，95%置信区间：1.0 - 4.9，P = 0.04）和贫血（风险比2.9，95%置信区间：1.2 - 7.2，P = 0.02）是18个月死亡率的预测因素。在多因素分析中，调整NYHA分级和LVEF后，贫血仍然是死亡的独立预测因素（风险比：2.6，95%置信区间：1.0 - 6.5，P = 0.04）。贫血患者的18个月生存率为67%（95%置信区间：45 - 89%），而血红蛋白水平正常的患者为87%（81 - 92%）（P = 0.016）。