Cardiology Department, St. Martino Hospital ASL 1, Belluno, Italy.
Intern Emerg Med. 2013 Mar;8(2):147-55. doi: 10.1007/s11739-011-0601-z. Epub 2011 May 5.
Observations available for patients with acute heart failure (HF) show conflicting results, and the prognostic role of anaemia ascertained on hospital admission is not well defined. We investigated the database of the Italian Survey on Acute Heart Failure (IS-AHF) to analyze prevalence, factors associated with and the prognostic role of anaemia (defined as haemoglobin < 12 g/dl) in patients hospitalized for acute HF with either depressed or preserved (>40%) ejection fraction (EF). The median haemoglobin level of the 2,318 patients considered in this analysis was 13 g/dl (inter-quartile range 11.5-14.3). The prevalence of anaemia was 31%. Patients who had anaemia were older, more frequently female gender, hospitalized for a chronic destabilized HF, had higher prevalence of preserved EF, hyponatremia, elevated troponin and other comorbidities (including diabetes, peripheral artery disease, chronic renal failure) than those who did not have anaemia. During the hospital stay, they were treated with higher doses of diuretics, and more frequently required mechanical ventilation and ultrafiltration, and less frequently received ACEi/ARB, aldosterone blockers and beta-blockers at hospital discharge. In-hospital mortality was 12.1 and 5.3% in patients with and without anaemia, respectively (p < 0.0001). In the multivariable analysis, anaemia was a significant independent predictor of in-hospital mortality apart from age, low systolic blood pressure, impaired renal function, elevated troponin assay, the non use of beta-blocker and the requirement of inotropic drug. In conclusion, anaemia diagnosed at hospital admission for acute HF is a frequent comorbidity with meaningful implications on the clinical management and prognosis both in patients with reduced and preserved EF.
观察急性心力衰竭（HF）患者的结果显示存在矛盾，入院时确定的贫血的预后作用尚不清楚。我们调查了意大利急性心力衰竭调查（IS-AHF）的数据库，以分析在因射血分数降低（<40%）或保留（>40%）而住院的急性 HF 患者中，贫血（定义为血红蛋白<12g/dl）的患病率、相关因素及其预后作用。在本分析中考虑的 2318 例患者的中位血红蛋白水平为 13g/dl（四分位间距 11.5-14.3）。贫血的患病率为 31%。贫血患者年龄较大，女性较多，因慢性不稳定 HF 住院，射血分数保留率较高，低钠血症、肌钙蛋白升高和其他合并症（包括糖尿病、外周动脉疾病、慢性肾功能衰竭）的发生率高于无贫血患者。住院期间，他们接受了更高剂量的利尿剂治疗，更频繁地需要机械通气和超滤，出院时较少接受 ACEi/ARB、醛固酮受体阻滞剂和β受体阻滞剂。住院期间死亡率分别为贫血组和无贫血组的 12.1%和 5.3%（p<0.0001）。多变量分析表明，除年龄、低收缩压、肾功能受损、肌钙蛋白检测升高、未使用β受体阻滞剂和需要正性肌力药物外，贫血是住院期间死亡率的独立显著预测因素。总之，急性 HF 入院时诊断的贫血是一种常见的合并症，对射血分数降低和保留的患者的临床管理和预后都有重要影响。
