Culleton Bruce F, Manns Braden J, Zhang Jianguo, Tonelli Marcello, Klarenbach Scott, Hemmelgarn Brenda R
Department of Medicine, University of Calgary, Foothills Hospital, Rm C210, 1403-29th St NW, Calgary, AB, Canada T2N 2T9.
Blood. 2006 May 15;107(10):3841-6. doi: 10.1182/blood-2005-10-4308. Epub 2006 Jan 10.
Although anemia is common in older adults, its prognostic significance is uncertain. A total of 17 030 community-dwelling subjects 66 years and older were identified between July 1 and December 31, 2001, and followed until December 31, 2004. Cox proportional hazards analyses were performed to determine the associations between anemia (defined as hemoglobin < 110 g/L) and hemoglobin and all-cause mortality, all-cause hospitalization, and cardiovascular-specific hospitalization. Overall, there were 1983 deaths and 7278 first hospitalizations. In patients with normal kidney function, adjusting for age, sex, diabetes mellitus, and comorbidity, anemia was associated with an increased risk for death (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.55-5.12), first all-cause hospitalization (HR, 2.16; 95% CI, 1.88-2.48), and first cardiovascular-specific hospitalization (HR, 2.49; 95% CI, 1.99-3.12). An inverse J-shaped relationship between hemoglobin and all-cause mortality was observed; the lowest risk for mortality occurred at hemoglobin values between 130 to 150 g/L for women and 140 to 170 g/L for men. Anemia is associated with an increased risk for hospitalization and death in community-dwelling older adults. Consideration should be given to redefine "normal" hemoglobin values in the elderly. Clinical trials are also necessary to determine whether anemia correction improves quality or quantity of life in this population.
尽管贫血在老年人中很常见，但其预后意义尚不确定。2001年7月1日至12月31日期间，共确定了17030名66岁及以上的社区居住受试者，并随访至2004年12月31日。进行Cox比例风险分析以确定贫血（定义为血红蛋白<110 g/L）和血红蛋白与全因死亡率、全因住院率和心血管特异性住院率之间的关联。总体而言，有1983例死亡和7278例首次住院。在肾功能正常的患者中，调整年龄、性别、糖尿病和合并症后，贫血与死亡风险增加相关（风险比[HR]，4.29；95%置信区间[CI]，3.55 - 5.12）、首次全因住院（HR，2.16；95% CI，1.88 - 2.48）和首次心血管特异性住院（HR，2.49；95% CI，1.99 - 3.12）。观察到血红蛋白与全因死亡率之间呈倒J形关系；女性血红蛋白值在130至150 g/L之间、男性在140至170 g/L之间时，死亡风险最低。贫血与社区居住老年人的住院和死亡风险增加相关。应考虑重新定义老年人的“正常”血红蛋白值。还需要进行临床试验来确定纠正贫血是否能改善该人群的生活质量或寿命。
