Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA.
Am J Clin Nutr. 2011 Sep;94(3):945-54. doi: 10.3945/ajcn.111.014639. Epub 2011 Aug 3.
It is not clear why cardiac or renal cachexia in chronic diseases is associated with poor cardiovascular outcomes. Platelet reactivity predisposes to thromboembolic events in the setting of atherosclerotic cardiovascular disease, which is often present in patients with end-stage renal disease (ESRD).
We hypothesized that ESRD patients with relative thrombocytosis (platelet count >300 × 10(3)/μL) have a higher mortality rate and that this association may be related to malnutrition-inflammation cachexia syndrome (MICS).
We examined the associations of 3-mo-averaged platelet counts with markers of MICS and 6-y all-cause and cardiovascular mortality (2001-2007) in a cohort of 40,797 patients who were receiving maintenance hemodialysis.
The patients comprised 46% women and 34% African Americans, and 46% of the patients had diabetes. The 3-mo-averaged platelet count was 229 ± 78 × 10(3)/μL. In unadjusted and case-mix adjusted models, lower values of albumin, creatinine, protein intake, hemoglobin, and dialysis dose and a higher erythropoietin dose were associated with a higher platelet count. Compared with patients with a platelet count of between 150 and 200 × 10(3)/μL (reference), the all-cause (and cardiovascular) mortality rate with platelet counts between 300 and <350, between 350 and <400, and ≥400 ×10(3)/μL were 6% (and 7%), 17% (and 15%), and 24% (and 25%) higher (P < 0.05), respectively. The associations persisted after control for case-mix adjustment, but adjustment for MICS abolished them.
Relative thrombocytosis is associated with a worse MICS profile, a lower dialysis dose, and higher all-cause and cardiovascular disease death risk in hemodialysis patients; and its all-cause and cardiovascular mortality predictability is accounted for by MICS. The role of platelet activation in cachexia-associated mortality warrants additional studies.
尚不清楚慢性疾病中心脏或肾脏恶病质为何与心血管不良结局相关。血小板反应性可导致动脉粥样硬化性心血管疾病患者发生血栓栓塞事件，而此类患者通常存在终末期肾病（ESRD）。
我们假设相对血小板增多症（血小板计数＞300×10³/μL）的 ESRD 患者死亡率更高，且这种相关性可能与营养不良-炎症-恶病质综合征（MICS）相关。
我们检测了 40797 例维持性血液透析患者中 3 个月平均血小板计数与 MICS 标志物及 6 年全因和心血管死亡率（2001-2007 年）的相关性。
患者中女性占 46%，非裔美国人占 34%，且 46%的患者患有糖尿病。3 个月平均血小板计数为 229±78×10³/μL。在未校正和病例组合校正模型中，白蛋白、肌酐、蛋白质摄入、血红蛋白和透析剂量较低以及促红细胞生成素剂量较高与血小板计数较高相关。与血小板计数在 150-200×10³/μL 之间的患者相比（参考），血小板计数在 300-＜350、350-＜400 和≥400×10³/μL 之间的全因（和心血管）死亡率分别升高 6%（和 7%）、17%（和 15%）和 24%（和 25%）（P＜0.05）。校正病例组合后，这些相关性仍然存在，但校正 MICS 后，这些相关性消失。
相对血小板增多症与血液透析患者较差的 MICS 谱、较低的透析剂量以及更高的全因和心血管疾病死亡风险相关；其全因和心血管死亡率的预测性归因于 MICS。血小板激活在恶病质相关死亡率中的作用需要进一步研究。
