Saint Luke's Mid-Asmerica Heart and Vascular Institute, Kansas City, MO 64111, USA.
Am Heart J. 2011 Aug;162(2):300-309.e3. doi: 10.1016/j.ahj.2011.05.021.
Hospital-acquired anemia (HAA) is common during acute myocardial infarction (AMI) and associated with higher long-term mortality. The relationship between HAA and adverse in-hospital outcomes may be particularly relevant to hospitals' efforts to implement prevention programs, but the association between HAA and in-hospital mortality is unclear.
We studied 17,676 patients with AMI with normal admission hemoglobin level who did not undergo bypass surgery. Hospital-acquired anemia was defined as development of new anemia during hospitalization (based on nadir hemoglobin) using age-, gender-, and race-specific criteria. In-hospital mortality of patients with mild (hemoglobin level less than HAA threshold but >11 g/dL), moderate (hemoglobin level 9-11 g/dL), and severe HAA (hemoglobin level, < 9 g/dL) was compared with those without HAA using hierarchical logistic regression, adjusting for site and potential confounders.
Hospital-acquired anemia developed in 10,166 patients (57.5%); 6,615 (37.4%) had mild; 2,740 (15.5%), moderate; and 811 (4.6%), severe HAA. In-hospital mortality was higher in patients with HAA and increased with HAA severity (no HAA 266 [3.5%], mild HAA 260 [3.9%], moderate HAA 222 [8.1%], and severe HAA 148 [18.3%], P < .001). The adjusted odds of in-hospital death were greater in patients with moderate (odds ratio 1.38, 95% CI 1.10-1.73) and severe HAA (3.39, 95% CI 2.59-4.44) versus no HAA.
Moderate and severe HAAs are independently associated with higher in-hospital mortality during AMI. Studies are needed to determine whether HAA is preventable and if preventing HAA improves outcomes.
医院获得性贫血（HAA）在急性心肌梗死（AMI）中很常见，并且与长期死亡率升高有关。HAA 与不良住院结局之间的关系可能与医院实施预防计划的努力特别相关，但 HAA 与住院死亡率之间的关系尚不清楚。
我们研究了 17676 名入院时血红蛋白水平正常且未接受旁路手术的 AMI 患者。根据年龄、性别和种族特异性标准，使用血红蛋白最低值，定义为住院期间出现新的贫血（新发生的贫血），发生医院获得性贫血。使用分层逻辑回归比较无 HAA 患者与轻度贫血（血红蛋白水平低于 HAA 阈值但>11g/dL）、中度贫血（血红蛋白水平 9-11g/dL）和重度贫血（血红蛋白水平<9g/dL）患者的住院死亡率，调整了地点和潜在混杂因素。
10166 例患者（57.5%）发生医院获得性贫血；6615 例（37.4%）为轻度贫血；2740 例（15.5%）为中度贫血；811 例（4.6%）为重度贫血。HAA 患者的住院死亡率更高，且随 HAA 严重程度增加而升高（无 HAA 为 266[3.5%]，轻度 HAA 为 260[3.9%]，中度 HAA 为 222[8.1%]，重度 HAA 为 148[18.3%]，P<0.001）。与无 HAA 相比，中度（比值比 1.38，95%CI 1.10-1.73）和重度 HAA（比值比 3.39，95%CI 2.59-4.44）患者住院死亡的调整比值更高。
中度和重度 HAA 与 AMI 期间住院死亡率升高独立相关。需要研究 HAA 是否可以预防以及预防 HAA 是否可以改善结局。
