Department of Medicine, University of Melbourne and Austin Health, Victoria, Australia.
Am J Cardiol. 2013 Apr 15;111(8):1187-91. doi: 10.1016/j.amjcard.2012.12.049. Epub 2013 Jan 30.
Anemia and chronic kidney disease are common in patients with heart failure (HF) and are associated with adverse outcomes. We analyzed the effect of cardiorenal anemia (CRA) syndrome, defined as anemia (hemoglobin <130 g/L for men, <120 g/L for women) and stage 3 or greater chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2)), in outpatients with HF. Consecutive patients with HF were prospectively enrolled from 2000 to 2005 (n = 748). The baseline clinical characteristics, pathology test results, and medication use were compared between those with and without CRA syndrome. The primary end point was all-cause mortality. The mean follow-up was 2.5 ± 1.6 years, with a left ventricular ejection fraction <45% present in 70% of patients. Angiotensin-converting enzyme inhibitors, β blockers, and spironolactone were used in 87%, 67%, and 37%, respectively. CRA syndrome was present in 224 patients (30%). These patients had greater all-cause mortality (51% vs 26%, p <0.001), older age (mean 77 ± 8 vs 67 ± 14 years, p <0.001), and greater rates of diabetes mellitus (35% vs 23%, p <0.001) and ischemic heart disease (50% vs 35%, p <0.001). The independent predictors of mortality were CRA syndrome (hazard ratio 2.0, 95% confidence interval 1.4 to 2.8, p <0.001), left ventricular systolic dysfunction per grade (hazard ratio 1.5, 95% confidence interval 1.3 to 1.8, p <0.001), the absence of a β blocker (hazard ratio 1.6, 95% confidence interval 1.1 to 2.2, p = 0.005), New York Heart Association class per class (hazard ratio 1.5, 95% confidence interval 1.2 to 1.9, p <0.01), and age per decade (hazard ratio 1.6, 95% confidence interval 1.4 to 2.0, p <0.001). In conclusion, CRA syndrome was common in patients with HF and was an independent predictor of all-cause mortality. Consideration should be given to identifying CRA syndrome and modifying reversible factors.
贫血和慢性肾脏病在心力衰竭（HF）患者中很常见，并且与不良结局相关。我们分析了定义为贫血（男性血红蛋白<130g/L，女性血红蛋白<120g/L）和 3 期或更严重的慢性肾脏病（估算肾小球滤过率<60ml/min/1.73m2）的心脏肾脏贫血（CRA）综合征对 HF 门诊患者的影响。连续前瞻性招募 2000 年至 2005 年的 HF 患者（n=748）。比较有和无 CRA 综合征患者的基线临床特征、病理检查结果和药物使用情况。主要终点是全因死亡率。平均随访 2.5±1.6 年，70%的患者左心室射血分数<45%。血管紧张素转换酶抑制剂、β受体阻滞剂和螺内酯的使用率分别为 87%、67%和 37%。224 例（30%）患者存在 CRA 综合征。这些患者的全因死亡率更高（51%比 26%，p<0.001），年龄更大（平均 77±8 岁比 67±14 岁，p<0.001），糖尿病（35%比 23%，p<0.001）和缺血性心脏病（50%比 35%，p<0.001）的发生率更高。死亡率的独立预测因素是 CRA 综合征（危险比 2.0，95%置信区间 1.4 至 2.8，p<0.001）、每级左心室收缩功能障碍（危险比 1.5，95%置信区间 1.3 至 1.8，p<0.001）、无β受体阻滞剂（危险比 1.6，95%置信区间 1.1 至 2.2，p=0.005）、纽约心脏协会（NYHA）心功能分级每增加一级（危险比 1.5，95%置信区间 1.2 至 1.9，p<0.01）和年龄每增加十年（危险比 1.6，95%置信区间 1.4 至 2.0，p<0.001）。总之，CRA 综合征在 HF 患者中很常见，是全因死亡率的独立预测因素。应考虑确定 CRA 综合征并纠正可纠正的因素。
