Felker G Michael, Allen Larry A, Pocock Stuart J, Shaw Linda K, McMurray John J V, Pfeffer Marc A, Swedberg Karl, Wang Duolao, Yusuf Salim, Michelson Eric L, Granger Christopher B
Duke Clinical Research Institute, Durham, North Carolina, USA.
J Am Coll Cardiol. 2007 Jul 3;50(1):40-7. doi: 10.1016/j.jacc.2007.02.067. Epub 2007 Jun 18.
The goal of this study was to identify potentially novel laboratory markers of risk in chronic heart failure patients.
Although a variety of prognostic markers have been described in heart failure, a systematic assessment of routine laboratory values has not been reported.
All 2,679 symptomatic chronic heart failure patients from the North American CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program had a wide range of laboratory measures performed at a core facility, enabling us to assess the relationship between routine blood tests and outcomes using a Cox proportional hazards model. We then replicated our findings in a cohort of 2,140 heart failure patients from the Duke Databank.
Among 36 laboratory values considered in the CHARM program, higher red cell distribution width (RDW) showed the greatest association with morbidity and mortality (adjusted hazard ratio 1.17 per 1-SD increase, p < 0.001). Higher RDW was among the most powerful overall predictors, with only age and cardiomegaly showing a better independent association with outcome. This finding was replicated in the Duke Databank, in which higher RDW was strongly associated with all-cause mortality (adjusted hazard ratio 1.29 per 1 SD, p < 0.001), second only to age as a predictor of outcome.
In 2 large contemporary heart failure populations, RDW was found to be a very strong independent predictor of morbidity and mortality. Understanding how and why this marker is associated with outcome may provide novel insights into heart failure pathophysiology.
本研究的目的是确定慢性心力衰竭患者潜在的新型风险实验室标志物。
尽管心力衰竭中已描述了多种预后标志物，但尚未有关于常规实验室值的系统评估报告。
北美CHARM（心力衰竭中坎地沙坦：死亡率和发病率降低评估）项目的所有2679例有症状的慢性心力衰竭患者在一个核心机构进行了广泛的实验室检测，这使我们能够使用Cox比例风险模型评估常规血液检测与预后之间的关系。然后我们在来自杜克数据库的2140例心力衰竭患者队列中重复了我们的发现。
在CHARM项目中考虑的36项实验室值中，较高的红细胞分布宽度（RDW）与发病率和死亡率的关联最大（每增加1个标准差，调整后的风险比为1.17，p<0.001）。较高的RDW是最有力的总体预测指标之一，只有年龄和心脏扩大与预后有更好的独立关联。这一发现在杜克数据库中得到了重复，其中较高的RDW与全因死亡率密切相关（每1个标准差调整后的风险比为1.29，p<0.001），作为预后预测指标仅次于年龄。
在2个大型当代心力衰竭人群中，发现RDW是发病率和死亡率非常强的独立预测指标。了解该标志物如何以及为何与预后相关，可能会为心力衰竭的病理生理学提供新的见解。
