Sjauw Krischan Daniël, van der Horst Iwan Cornelis Clemens, Nijsten Maarten Willem Nicolaas, Nieuwland Wybe, Zijlstra Felix
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Am J Cardiol. 2006 May 15;97(10):1435-40. doi: 10.1016/j.amjcard.2005.12.034. Epub 2006 Mar 27.
Most risk-stratification instruments that have been developed to predict outcome after myocardial infarction do not make use of laboratory parameters, although several laboratory parameters have been shown to be predictors of adverse outcome. To assess the prognostic value of routine admission laboratory tests, we studied a sample of 264 of 3,746 patients with myocardial infarction from a coronary care unit database of 12,043 patients for differences between survivors and nonsurvivors at 30 days. In multivariate analyses, higher white blood cell count, higher levels of serum creatinine, glucose, and lactate dehydrogenase, and lower platelet count were identified as independent risk factors for 30-day mortality. The model that incorporated these risk factors (added laboratory parameters model) had a 17% higher predictive power than did the model that contained only conventional risk factors (conventional risk factor model). The added laboratory parameters model showed better discriminative ability than the conventional risk factor model according to the area under the curve (0.87 vs 0.80). In conclusion, routine admission laboratory tests hold significant prognostic information, with value in addition to conventional risk factors. Incorporating these tests in risk-stratification instruments will further improve risk assessment of patients with myocardial infarction.
尽管多项实验室指标已被证明是不良预后的预测指标，但大多数已开发用于预测心肌梗死后预后的风险分层工具并未使用实验室参数。为了评估常规入院实验室检查的预后价值，我们从一个包含12,043例患者的冠心病监护病房数据库中，选取了3,746例心肌梗死患者中的264例样本，研究存活者与非存活者在30天时的差异。在多变量分析中，较高的白细胞计数、血清肌酐、葡萄糖和乳酸脱氢酶水平以及较低的血小板计数被确定为30天死亡率的独立危险因素。纳入这些危险因素的模型（添加实验室参数模型）比仅包含传统危险因素的模型（传统危险因素模型）具有高17%的预测能力。根据曲线下面积，添加实验室参数模型比传统危险因素模型具有更好的判别能力（0.87对0.80）。总之，常规入院实验室检查具有重要的预后信息，其价值除了传统危险因素之外。将这些检查纳入风险分层工具将进一步改善心肌梗死患者的风险评估。
