Zakai Neil A, Katz Ronit, Hirsch Calvin, Shlipak Michael G, Chaves Paulo H M, Newman Anne B, Cushman Mary
Department of Medicine, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, USA.
Arch Intern Med. 2005 Oct 24;165(19):2214-20. doi: 10.1001/archinte.165.19.2214.
Anemia is viewed as a negative prognostic factor in the elderly population; its independent impact on survival is unclear.
Baseline hemoglobin quintiles and anemia, as defined by the World Health Organization criteria, were assessed in relation to mortality in the Cardiovascular Health Study, a prospective cohort study with 11.2 years of follow-up of 5888 community-dwelling men and women 65 years or older, enrolled in 1989-1990 or 1992-1993 in 4 US communities.
A total of 1205 participants were in the lowest hemoglobin quintile (<13.7 g/dL for men; <12.6 g/dL for women), and 498 (8.5%) were anemic (<13 g/dL for men; <12 g/dL for women). A reverse J-shaped relationship with mortality was observed; age-, sex-, and race-adjusted hazard ratios (95% confidence interval [CI]) in the first and fifth quintiles, compared with the fourth quintile, were 1.42 (95% CI, 1.25-1.62) and 1.24 (95% CI, 1.09-1.42). After multivariate adjustment, these hazard ratios were 1.33 (95% CI, 1.15-1.54) and 1.17 (95% CI, 1.01-1.36). The demographic- and fully-adjusted hazard ratios of anemia for mortality were 1.57 (95% CI, 1.38-1.78) and 1.38 (95% CI, 1.19-1.54). Adjustment for causes and consequences of anemia (renal function, inflammation, or frailty) did not reduce associations.
Lower and higher hemoglobin concentrations and anemia by World Health Organization criteria were independently associated with increased mortality. The World Health Organization criteria did not identify risk as well as a lower hemoglobin value. Additional study is needed on the clinically valid definition for and causes of anemia in the elderly and on the increased mortality at the extremes of hemoglobin concentrations.
贫血被视为老年人群的不良预后因素；其对生存的独立影响尚不清楚。
在心血管健康研究中，根据世界卫生组织标准评估了基线血红蛋白五分位数和贫血情况，并分析其与死亡率的关系。该研究为前瞻性队列研究，于1989 - 1990年或1992 - 1993年在美国4个社区招募了5888名65岁及以上的社区居住男性和女性，随访11.2年。
共有1205名参与者处于最低血红蛋白五分位数（男性<13.7 g/dL；女性<12.6 g/dL），498名（8.5%）贫血（男性<13 g/dL；女性<12 g/dL）。观察到与死亡率呈倒J形关系；与第四五分位数相比，第一和第五五分位数经年龄、性别和种族调整后的风险比（95%置信区间[CI]）分别为1.42（95% CI，1.25 - 1.62）和1.24（95% CI，1.09 - 1.42）。多因素调整后，这些风险比分别为1.33（95% CI，1.15 - 1.54）和1.17（95% CI，1.01 - 1.36）。贫血经人口统计学和全面调整后的死亡率风险比为1.57（95% CI，1.38 - 1.78）和1.38（95% CI，1.19 - 1.54）。对贫血的原因和后果（肾功能、炎症或虚弱）进行调整并未降低相关性。
根据世界卫生组织标准，较低和较高的血红蛋白浓度以及贫血与死亡率增加独立相关。世界卫生组织标准识别风险的能力不如较低的血红蛋白值。需要进一步研究老年人贫血的临床有效定义和原因，以及血红蛋白浓度极端值时死亡率增加的情况。
