Sanchis Juan, Bodí Vicent, Núñez Julio, Bertomeu Vicente, Consuegra Luciano, Bosch María José, Gómez Cristina, Bosch Xavier, Chorro Francisco Javier, Llácer Angel
Servei de Cardiologia, Hospital Clinic Universitari, Universitat de València, València, Spain.
Am J Cardiol. 2006 Oct 1;98(7):885-9. doi: 10.1016/j.amjcard.2006.04.029. Epub 2006 Aug 4.
Little is known about the prognostic value of leukocyte count on admission for patients with chest pain. In total, 1,461 patients who presented to the emergency department with non-ST-segment elevation chest pain were studied by clinical history, electrocardiography, serial troponin I determination, and leukocyte count on admission. End points were 1-year mortality and major events (mortality or infarction). Overall patient distribution by quartiles of leukocyte count showed increased mortality (6%, 7%, 6%, and 17%, p = 0.0001) and major events (13%, 13%, 15%, and 24%, p = 0.0001) in the fourth quartile. After adjustment for other risk factors, the fourth quartile cut-off value (>10,000 cells/ml) predicted mortality (hazard ratio 2.0, 95% confidence interval 1.4 to 2.8, p = 0.0001) but not major events (p = 0.07). When analysis was performed to assess troponin status, in the subgroup with increased troponin (n = 634, 16% mortality), a leukocyte count >10,000 cells/ml was related to mortality (hazard ratio 2.2, 95% confidence interval 1.5 to 3.4, p = 0.0001). However, in the subgroup with normal troponin levels (n = 827, 4.2% mortality), there were no differences in mortality between patients with or without a leukocyte count >10,000 cells/ml (4.4% vs 4.2%, p = 0.8), with survival curves showing a tight overlap (p = 0.9). Further, in the subgroup with normal troponin levels, leukocyte count was not significantly different between patients with or without ST depression (7,969 +/- 2,171 vs 8,108 +/- 2,356 cells/ml, p = 0.6) and was not associated with mortality in patients with ST depression (p = 0.7). In conclusion, leukocyte count on admission is predictive of mortality in patients with chest pain and non-ST-segment elevation myocardial infarction. However, in the absence of myocardial necrosis, leukocyte count lacks prognostic value.
关于胸痛患者入院时白细胞计数的预后价值，目前所知甚少。本研究共纳入1461例因非ST段抬高型胸痛就诊于急诊科的患者，通过临床病史、心电图、连续肌钙蛋白I测定以及入院时白细胞计数进行研究。终点指标为1年死亡率和主要事件（死亡或梗死）。根据白细胞计数四分位数的总体患者分布显示，第四四分位数的死亡率（分别为6%、7%、6%和17%，p = 0.0001）和主要事件发生率（分别为13%、13%、15%和24%，p = 0.0001）均有所增加。在对其他危险因素进行校正后，第四四分位数的临界值（>10,000个细胞/ml）可预测死亡率（风险比2.0，95%置信区间1.4至2.8，p = 0.0001），但不能预测主要事件（p = 0.07）。在评估肌钙蛋白状态的分析中，在肌钙蛋白升高的亚组（n = 634，死亡率16%）中，白细胞计数>10,000个细胞/ml与死亡率相关（风险比2.2，95%置信区间1.5至3.4，p = 0.0001）。然而，在肌钙蛋白水平正常的亚组（n = 827，死亡率4.2%）中，白细胞计数>10,000个细胞/ml的患者与未超过该水平的患者在死亡率上无差异（4.4%对4.2%，p = 0.8），生存曲线显示紧密重叠（p = 0.9）。此外，在肌钙蛋白水平正常的亚组中，有ST段压低和无ST段压低的患者白细胞计数无显著差异（7,969±2,171对8,108±2,356个细胞/ml，p = 0.6），且ST段压低患者的白细胞计数与死亡率无关（p = 0.7）。总之，入院时白细胞计数可预测胸痛和非ST段抬高型心肌梗死患者的死亡率。然而，在无心肌坏死的情况下，白细胞计数缺乏预后价值。
