基线白细胞计数是非ST段抬高型急性冠脉综合征患者长期心血管死亡率的独立预测因素，但它并不能改善GRACE评分的风险分级。
Baseline white blood cell count is an independent predictor of long-term cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome, but it does not improve the risk classification of the GRACE score.
作者信息
Taglieri Nevio, Bacchi Reggiani Maria Letizia, Palmerini Tullio, Cinti Laura, Saia Francesco, Guastaroba Paolo, Marrozzini Cinzia, Moretti Carolina, Montefiori Michela, Rosmini Stefania, Alessi Laura, Vagnarelli Fabio, Branzi Angelo, Rapezzi Claudio, Marzocchi Antonio
机构信息
Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna, Italy.
出版信息
Cardiology. 2013;124(2):97-104. doi: 10.1159/000346377. Epub 2013 Feb 7.
OBJECTIVES
To investigate the prognostic significance of baseline white blood cell count (WBCc) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its additive predictive value beyond the Global Registry of Acute Coronary Events (GRACE) score.
METHODS
We included 1,315 consecutive NSTE-ACS patients. Patients were divided in quartiles according to the WBCc (cells per 1 mm(3)) i.e. Q1 <6,850, Q2 = 6,850-8,539, Q3 = 8,540-10,857 and Q4 ≥10,858. The study end point was 3-year cardiovascular death (CVD).
RESULTS
The median age of the study population was 76 years. Overall, 335 patients (25.5%) died with 211 of these (16%) suffering from CVD. Patients in Q4 showed a higher cumulative probability of CVD compared to patients in Q1-Q3. On multivariable analysis, patients in Q4 were at higher risk of CVD [hazard ratio (HR) = 1.47, 95% confidence interval (CI) 1.09-1.98, p = 0.011]. WBCc as a continuous variable was also independently associated with the study end point (HR = 1.043; 95% CI 1.02-1.07; p = 0.001). However, the incorporation of WBCc into the GRACE score did not improve either prediction of risk (C-index = 0.796 for GRACE score with or without WBCc) or classification of risk [relative integrated discrimination improvement = 0.0154, 95% CI) -0.029 to 0.0618; continuous net reclassification improvement = -0.0676, 95% CI -0.2149-0.0738).
CONCLUSIONS
WBCc was an independent predictor of 3-year CVD in patients with NSTE-ACS. However, it did not add prognostic information beyond the GRACE score.
目的
探讨非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者基线白细胞计数（WBCc）的预后意义及其在全球急性冠状动脉事件注册研究（GRACE）评分之外的附加预测价值。
方法
我们纳入了1315例连续的NSTE-ACS患者。根据WBCc（每立方毫米细胞数）将患者分为四分位数，即Q1<6850、Q2 = 6850-8539、Q3 = 8540-10857和Q4≥10858。研究终点为3年心血管死亡（CVD）。
结果
研究人群的中位年龄为76岁。总体而言，335例患者（25.5%）死亡，其中211例（16%）死于CVD。与Q1-Q3组患者相比，Q4组患者CVD的累积概率更高。多变量分析显示，Q4组患者发生CVD的风险更高[风险比（HR）= 1.47，95%置信区间（CI）1.09-1.98，p = 0.011]。WBCc作为连续变量也与研究终点独立相关（HR = 1.043；95% CI 1.02-1.07；p = 0.001）。然而，将WBCc纳入GRACE评分既未改善风险预测（无论是否纳入WBCc，GRACE评分的C指数均为0.796），也未改善风险分类[相对综合鉴别改善= 0.0154，95% CI -0.029至0.0618；连续净重新分类改善= -0.0676，95% CI -0.2149-0.0738]。
结论
WBCc是NSTE-ACS患者3年CVD的独立预测因子。然而，它并未在GRACE评分之外增加预后信息。
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