心力衰竭伴射血分数降低患者住院期间入院时和出院时贫血的临床特征和预后价值：EVEREST 试验的结果。
Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial.
机构信息
From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
出版信息
Circ Heart Fail. 2014 May;7(3):401-8. doi: 10.1161/CIRCHEARTFAILURE.113.000840. Epub 2014 Apr 15.
BACKGROUND
Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge.
METHODS AND RESULTS
An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05-1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37-2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73-1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1).
CONCLUSIONS
Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
背景
贫血与慢性心力衰竭（HF）患者的预后不良相关。我们旨在描述入院或出院时患有贫血的住院 HF 患者的临床特征和出院后结局。
方法和结果
对 EVEREST 试验中 3731 例（90%）射血分数≤40%的住院 HF 患者进行了分析，这些患者基线时有血红蛋白数据，比较了入院时或出院时/第 7 天有和无贫血（女性血红蛋白<12 g/dL，男性血红蛋白<13 g/dL）患者的临床特征和结局（全因死亡率和心血管死亡率或 HF 住院率）。总体而言，1277 例患者（34%）基线时贫血，其中 73%的患者在出院时持续存在贫血，27%的患者贫血缓解；6%的无基线贫血的患者在出院或第 7 天发生贫血。与无贫血的患者相比，贫血患者年龄较大，血压较低，血肌酐和利钠肽水平较高（均 P<0.05）。在风险调整后，出院时而非入院时的贫血与全因死亡率增加独立相关（风险比，1.30；95%置信区间，1.05-1.60；P=0.015；和风险比，0.94；95%置信区间，0.76-1.15；P=0.53），以及出院后早期（≤100 天）心血管死亡率加 HF 住院率（风险比，1.73；95%置信区间，1.37-2.18；P<0.001；和风险比，0.92；95%置信区间，0.73-1.16；P=0.47）。在调整分析中，基线和出院时的贫血均与长期心血管死亡率加 HF 住院率（>100 天）无关（均 P>0.1）。
结论
在射血分数降低的住院 HF 患者中，出院时的轻度贫血但不是基线时的贫血与全因死亡率和短期心血管死亡率加 HF 住院率增加相关。
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