Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France; INSERM U1094, Tropical Neuroepidemiology, Limoges, France; CNRS FR 3503 GEIST, Limoges, France.
INSERM U1094, Tropical Neuroepidemiology, Limoges, France; CNRS FR 3503 GEIST, Limoges, France; Department of Cardiology, Dupuytren University Hospital, Limoges, France.
Eur J Vasc Endovasc Surg. 2014 Aug;48(2):202-7. doi: 10.1016/j.ejvs.2014.04.005. Epub 2014 Jun 14.
Anemia is associated with poorer outcome in coronary artery disease (CAD) and heart failure (HF), but data on patients with peripheral artery disease (PAD) are scarce, especially regarding the local (limb) prognosis. It was hypothesized that anemia is associated with poorer prognosis in patients hospitalized for PAD, and this relationship would be proportional to the severity of the anemia.
Prospective cohort study.
The Cohorte des Patients Artéritiques (COPART) is a multicenter registry of patients hospitalized for PAD in three university hospitals in southwestern France.
Clinical and biological data were collected at entry. Patients were followed up to 1 year. Anemia was defined by Hb < 8.2 mmol/L in men and <7.6 mmol/L in women. The primary outcome was 1-year survival free from major amputation. The secondary outcome was 1-year major amputation.
Data of 925 consecutive patients (70.7 ± 12.8 years, 29.2% females) were analyzed. Patients were hospitalized either for revascularization or medical therapy, with Rutherford categories 3 (25%), 4 (9.1%), 5 or 6 (55.1%) as well as acute limb ischemia (10.8%). Anemia was present in 471 patients (50.9%). These patients were significantly older, with higher rates of hypertension, diabetes, clinical CAD, HF, chronic kidney disease, and cancer, and with lower rates of smoking and dyslipidemia than their counterparts (p < .05 for all). In multivariate models, anemia was significantly and independently associated (p < 0.001) with death and amputation (HR 1.44; 95% CI 1.15-1.80) with similar findings for secondary outcomes. A lower level of hemoglobin is associated with a higher risk of mortality and amputation (HR 1.20; 95% CI 1.09-1.32).
Anemia and its severity are independent predictors of mortality and limb loss in patients hospitalized for PAD.
贫血与冠心病（CAD）和心力衰竭（HF）的预后较差相关，但外周动脉疾病（PAD）患者的数据很少，特别是关于局部（肢体）预后的数据。据推测，贫血与因 PAD 住院的患者预后较差相关，且这种关系与贫血的严重程度成正比。
前瞻性队列研究。
Cohorte des Patients Artéritiques（COPART）是一项多中心登记研究，纳入了法国西南部 3 家大学医院因 PAD 住院的患者。
在入组时收集临床和生物学数据。对患者进行为期 1 年的随访。贫血定义为男性 Hb < 8.2 mmol/L，女性 Hb < 7.6 mmol/L。主要结局为无重大截肢的 1 年生存率。次要结局为 1 年主要截肢率。
共分析了 925 例连续患者的数据（70.7 ± 12.8 岁，29.2%为女性）。患者因血运重建或药物治疗而住院，Rutherford 分类为 3 级（25%）、4 级（9.1%）、5 级或 6 级（55.1%）和急性肢体缺血（10.8%）。471 例（50.9%）患者存在贫血。与无贫血患者相比，这些患者年龄更大，高血压、糖尿病、临床 CAD、HF、慢性肾脏病和癌症的发生率更高，而吸烟和血脂异常的发生率更低（p <.05）。多变量模型显示，贫血与死亡和截肢显著相关（p < 0.001），次要结局也有类似发现。较低的血红蛋白水平与更高的死亡率和截肢风险相关（HR 1.44；95% CI 1.15-1.80）。
贫血及其严重程度是 PAD 住院患者死亡和肢体丧失的独立预测因素。
