Groenveld Hessel F, Januzzi James L, Damman Kevin, van Wijngaarden Jan, Hillege Hans L, van Veldhuisen Dirk J, van der Meer Peter
Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
J Am Coll Cardiol. 2008 Sep 2;52(10):818-27. doi: 10.1016/j.jacc.2008.04.061.
The aim of this study was to assess the effect of anemia on mortality in chronic heart failure (CHF).
Anemia is frequently observed in patients with CHF, and evidence suggests that anemia might be associated with an increased mortality.
A systematic literature search in MEDLINE (through November 2007) for English language articles was performed. In addition, a manual search was performed. We included cohort studies and retrospective secondary analyses of randomized controlled trials whose primary objective was to analyze the association between anemia and mortality in CHF. Of a total of 1,327 initial studies, we included 34 studies, comprising 153,180 patients. Information on study design, patient characteristics, outcome, and potential confounders were extracted.
Anemia was defined by criteria used in the original articles. Of the 153,180 CHF patients, 37.2% were anemic. After a minimal follow-up of 6 months, 46.8% of anemic patients died compared with 29.5% of nonanemic patients. Crude mortality risk of anemia was odds ratio 1.96 (95% confidence interval: 1.74 to 2.21, p < 0.001). Lower baseline hemoglobin values were associated with increased crude mortality rates (r = -0.396, p = 0.025). Adjusted hazard ratios showed an increased adjusted risk for anemia (hazard ratio 1.46 [95% confidence interval: 1.26 to 1.69, p < 0.001]). Subgroup analysis showed no significant difference between mortality risk of anemia in diastolic or systolic CHF.
Anemia is associated with an increased risk of mortality in both systolic and diastolic CHF. Anemia should, therefore, be considered as a useful prognosticator, and therapeutic strategies aimed to increase hemoglobin levels in CHF should be investigated.
本研究旨在评估贫血对慢性心力衰竭（CHF）患者死亡率的影响。
CHF患者中经常出现贫血，有证据表明贫血可能与死亡率增加有关。
在MEDLINE数据库中进行系统的文献检索（截至2007年11月），检索英文文章。此外，还进行了手工检索。我们纳入了队列研究以及随机对照试验的回顾性二次分析，其主要目的是分析贫血与CHF患者死亡率之间的关联。在总共1327项初始研究中，我们纳入了34项研究，共153180例患者。提取了有关研究设计、患者特征、结局和潜在混杂因素的信息。
贫血根据原始文章中使用的标准进行定义。在153180例CHF患者中，37.2%为贫血患者。经过至少6个月的随访，46.8%的贫血患者死亡，而非贫血患者的死亡率为29.5%。贫血患者的粗死亡率风险比值比为1.96（95%置信区间：1.74至2.21，p<0.001）。较低的基线血红蛋白值与粗死亡率增加相关（r = -0.396，p = 0.025）。调整后的风险比显示贫血患者的调整后风险增加（风险比1.46 [95%置信区间：1.26至1.69，p<0.001]）。亚组分析显示，舒张性或收缩性CHF患者贫血的死亡风险之间无显著差异。
贫血与收缩性和舒张性CHF患者的死亡风险增加相关。因此，贫血应被视为一个有用的预后指标，并且应研究旨在提高CHF患者血红蛋白水平的治疗策略。
