急性冠脉综合征患者住院期间血红蛋白下降的预后影响

Prognostic impact of hemoglobin drop during hospital stay in patients with acute coronary syndromes.

作者信息

Nabais Sérgio, Gaspar Antonio, Costa João, Azevedo Pedro, Rocha Sérgia, Torres Márcia, Pereira Miguel Alvares, Correia Adelino

机构信息

Serviço de Cardiologia, Hospital de S. Marcos, Braga, Portugal.

出版信息

Rev Port Cardiol. 2009 Apr;28(4):383-95.

PMID:19634496

Abstract

INTRODUCTION

Bleeding is currently the most common non-cardiac complication of therapy in patients with acute coronary syndromes (ACS), and may itself be associated with adverse outcomes. The aim of this study was to determine the effect of hemoglobin drop during hospital stay on outcome among patients with ACS.

METHODS

Using Cox proportional-hazards modeling, we examined the association between hemoglobin drop and death or myocardial infarction (MI) at 6 months in 1172 patients admitted with ACS to an intensive cardiac care unit. Patients were stratified according to quartiles of hemoglobin drop: Q1, < or = 0.8 g/dL; Q2, 0.9-1.5 g/dL; Q3, 1.6-2.3 g/dL; Q4, > or = 2.4 g/dL. We also identified independent predictors of increased hemoglobin drop (> or =2.4 g/dL) using multivariate logistic regression analysis.

RESULTS

Median nadir hemoglobin concentration was 1.5 g/dL lower (IQR 0.8-2.3) compared with baseline hemoglobin (p < 0.0001). Independent predictors of increased hemoglobin drop included older Sage, renal dysfunction, lower weight, and use of thrombolytic therapy, glycoprotein IIb/IIIa inhibitors, nitrates, and percutaneous coronary intervention. Higher levels of hemoglobin drop were associated with increased rates of 6-month mortality (8.0% vs. 9.4% vs. 9.6% vs. 15.7%; p for trend = 0.014) and 6-month death/ MI (12.4% vs. 17.0% vs. 17.2% vs. 22.1%; p for trend = 0.021). Using Q1 as reference group, the adjusted hazard ratio (HR) for 6-month mortality and 6-month death/MI among patients in the highest quartile of hemoglobin drop was 1.83 (95% confidence interval [CI] 1.08-3.11; p = 0.026) and 1.60 (95% CI 1.04-2.44; p = 0.031) respectively. Considered as a continuous variable, the adjusted HR for 6-month mortality was 1.16 (95% CI 1.01-1.32; p = 0.030) per 1 g/dL increase in hemoglobin drop.

CONCLUSIONS

A decrease in hemoglobin frequently occurs during hospitalization for ACS and is independently associated with adverse outcomes.

摘要

引言

出血是目前急性冠脉综合征（ACS）患者治疗中最常见的非心脏并发症，其本身可能与不良预后相关。本研究旨在确定住院期间血红蛋白下降对ACS患者预后的影响。

方法

我们使用Cox比例风险模型，研究了1172例入住重症心脏监护病房的ACS患者血红蛋白下降与6个月时死亡或心肌梗死（MI）之间的关联。根据血红蛋白下降的四分位数对患者进行分层：Q1，≤0.8 g/dL；Q2，0.9 - 1.5 g/dL；Q3，1.6 - 2.3 g/dL；Q4，≥2.4 g/dL。我们还使用多变量逻辑回归分析确定了血红蛋白下降增加（≥2.4 g/dL）的独立预测因素。

结果

与基线血红蛋白相比，最低血红蛋白浓度中位数低1.5 g/dL（四分位间距0.8 - 2.3）（p < 0.0001）。血红蛋白下降增加的独立预测因素包括年龄较大、肾功能不全、体重较低以及使用溶栓治疗、糖蛋白IIb/IIIa抑制剂、硝酸盐和经皮冠状动脉介入治疗。较高水平的血红蛋白下降与6个月死亡率增加（8.0%对9.4%对9.6%对15.7%；趋势p = 0.014）和6个月死亡/MI增加（12.4%对17.0%对17.2%对22.1%；趋势p = 0.021）相关。以Q1作为参照组，血红蛋白下降最高四分位数的患者6个月死亡率和6个月死亡/MI的调整风险比（HR）分别为1.83（95%置信区间[CI] 1.08 - 3.11；p = 0.026）和1.60（95% CI 1.04 - 2.44；p = 0.031）。作为连续变量考虑，血红蛋白下降每增加1 g/dL，6个月死亡率的调整HR为1.16（95% CI 1.01 - 1.32；p = 0.030）。