Grzybowski Mary, Welch Robert D, Parsons Lori, Ndumele Chiadi E, Chen Edmond, Zalenski Robert, Barron Hal V
Department of Emergency Medicine, Wayne State University School of Medicine, 6G University Health Center, 4201 St. Antoine, Detroit, MI 48201, USA.
Acad Emerg Med. 2004 Oct;11(10):1049-60. doi: 10.1197/j.aem.2004.06.005.
Although cross-sectional and prospective studies have shown that the white blood cell (WBC) count is associated with long-term mortality for patients with ischemic heart disease, the role of the WBC count as an independent predictor of short-term mortality in patients with acute myocardial infarction (AMI) has not been examined as extensively. The objective of this study was to determine whether the WBC count is associated with in-hospital mortality for patients with ischemic heart disease after controlling for potential confounders.
From July 31, 2000, to July 31, 2001, the National Registry of Myocardial Infarction 4 enrolled 186,727 AMI patients. A total of 115,273 patients were included in the analysis.
WBC counts were subdivided into intervals of 1,000/mL, and in-hospital mortality rates were determined for each interval. The distribution revealed a J-shaped curve. Patients with WBC counts >5,000/mL were subdivided into quartiles, whereas patients with WBC counts <5,000/mL were assigned to a separate category labeled "subquartile" and were analyzed separately. A linear increase in in-hospital mortality by WBC count quartile was found. The unadjusted odds ratio (OR) for the fourth versus the first quartile showed strong associations with in-hospital mortality among the entire population and by gender: 4.09 (95% confidence interval [95% CI] = 3.83 to 4.73) for all patients, 4.31 (95% CI = 3.93 to 4.73) for men, and 3.65 (95% CI = 3.32 to 4.01) for women. Following adjustment for covariates, the magnitude of the ORs attenuated, but the ORs remained highly significant (OR, 2.71 [95% CI = 2.53 to 2.90] for all patients; OR, 2.87 [95% CI = 2.59 to 3.19] for men; OR, 2.61 [95% CI = 2.36 to 2.99] for women). Reperfused patients had consistently lower in-hospital mortality rates for all patients and by gender (p < 0.0001).
The WBC count is an independent predictor of in-hospital AMI mortality and may be useful in assessing the prognosis of AMI in conjunction with other early risk-stratification factors. Whether elevated WBC count is a marker of the inflammatory process or is a direct risk factor for AMI remains unclear. Given the simplicity and availability of the WBC count, the authors conclude that the WBC count should be used in conjunction with other ancillary tests to assess the prognosis of a patient with AMI.
尽管横断面研究和前瞻性研究表明，白细胞（WBC）计数与缺血性心脏病患者的长期死亡率相关，但白细胞计数作为急性心肌梗死（AMI）患者短期死亡率独立预测指标的作用尚未得到广泛研究。本研究的目的是确定在控制潜在混杂因素后，白细胞计数是否与缺血性心脏病患者的院内死亡率相关。
从2000年7月31日至2001年7月31日，心肌梗死国家注册研究4纳入了186,727例AMI患者。共有115,273例患者纳入分析。
白细胞计数被分为每1000/mL的区间，并确定每个区间的院内死亡率。分布呈J形曲线。白细胞计数>5000/mL的患者被分为四分位数，而白细胞计数<5000/mL的患者被归为一个单独的类别，标记为“亚四分位数”，并单独进行分析。发现院内死亡率随白细胞计数四分位数呈线性增加。未调整的第四四分位数与第一四分位数的比值比（OR）显示，在整个人口中以及按性别与院内死亡率有很强的关联：所有患者为4.09（95%置信区间[95%CI]=3.83至4.73），男性为4.31（95%CI=3.93至4.73），女性为3.65（95%CI=3.32至4.01）。在对协变量进行调整后，OR的幅度减弱，但OR仍然高度显著（所有患者的OR为2.71[95%CI=2.53至2.90]；男性的OR为2.87[95%CI=2.59至3.19]；女性的OR为2.61[95%CI=2.36至2.99]）。再灌注患者在所有患者中以及按性别计算的院内死亡率始终较低（p<0.0001）。
白细胞计数是AMI院内死亡率的独立预测指标，可能有助于结合其他早期风险分层因素评估AMI的预后。白细胞计数升高是炎症过程的标志物还是AMI的直接危险因素仍不清楚。鉴于白细胞计数的简单性和可获得性，作者得出结论，白细胞计数应与其他辅助检查结合使用，以评估AMI患者的预后。
