University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Am Coll Cardiol. 2013 May 14;61(19):1973-81. doi: 10.1016/j.jacc.2012.12.050. Epub 2013 Mar 14.
The study sought to investigate the clinical correlates and prognostic role of anemia and changes in hemoglobin in patients hospitalized for acute decompensated heart failure (AHF).
Anemia is related to a poor outcome in patients with heart failure. In addition, an increase in hemoglobin during hospitalization might be a sign of effective decongestion and therefore related to improved outcome.
This is a post hoc analysis of the PROTECT (Placebo-Controlled Randomized Study of the Selective Adenosine A1 Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function) study in 1,969 patients with AHF and mild to moderate impaired renal function. Hemoglobin levels were measured daily for the first 4 days and at day 7. The endpoint was 180-day all-cause mortality.
Anemia at baseline was observed in 50.3% of the patients. During follow-up, 359 patients (18.2%) died. Hemoglobin increased in 69.1% and was associated with a better renal function at baseline and more weight loss, but was associated with a deterioration of renal function (p = 0.01), whereas total dose diuretics was lower in patients with hemoconcentration (p < 0.01). Interaction analysis showed that greater weight loss and better baseline renal function were associated with a more rapid increase in hemoglobin concentration (p < 0.01 for both). The absolute change in hemoglobin (g/dl) independently predicted outcome (hazard ratio: 0.66; 95% confidence interval: 0.51 to 0.86; p = 0.002), whereas baseline hemoglobin levels did not.
Patients with AHF and preserved renal function are decongested better, as shown by an increase in hemoglobin. A rapid increase in hemoglobin during the first week is independently associated with a favorable outcome, despite a slight decrease in renal function.
本研究旨在探讨急性失代偿性心力衰竭（AHF）住院患者贫血及血红蛋白变化的临床相关性和预后价值。
贫血与心力衰竭患者的不良预后相关。此外，住院期间血红蛋白升高可能是有效利尿的标志，因此与改善预后相关。
这是 PROTECT（选择性腺苷 A1 受体拮抗剂罗洛非林治疗急性失代偿性心力衰竭和容量超负荷患者的安慰剂对照随机研究，以评估充血和肾功能治疗效果）研究中 1969 例 AHF 合并轻度至中度肾功能受损患者的事后分析。前 4 天每天测量血红蛋白水平，第 7 天测量一次。终点为 180 天全因死亡率。
基线时 50.3%的患者存在贫血。随访期间，359 例患者（18.2%）死亡。血红蛋白升高见于 69.1%的患者，且与基线时肾功能较好和体重减轻较多相关，但与肾功能恶化相关（p=0.01），而血容量浓缩患者的利尿剂总剂量较低（p<0.01）。交互分析显示，更大的体重减轻和更好的基线肾功能与血红蛋白浓度更快的升高相关（p<0.01）。血红蛋白绝对值的变化（g/dl）独立预测结局（危险比：0.66；95%置信区间：0.51 至 0.86；p=0.002），而基线血红蛋白水平则不能。
保留肾功能的 AHF 患者利尿效果更好，表现为血红蛋白升高。第 1 周血红蛋白快速升高与有利结局独立相关，尽管肾功能略有下降。
