Sánchez-Martínez Marianela, López-Cuenca Angel, Marín Francisco, Flores-Blanco Pedro J, García Narbon Andrea, de las Heras-Gómez Ignacio, Sánchez-Galian María J, Valdés-Chávarri Mariano, Januzzi James L, Manzano-Fernández Sergio
Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Departamento de Medicina Interna, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain.
Rev Esp Cardiol (Engl Ed). 2014 Oct;67(10):830-6. doi: 10.1016/j.rec.2013.12.018. Epub 2014 May 16.
Red cell distribution width has been linked to an increased risk for in-hospital bleeding in patients with non-ST-segment elevation acute coronary syndrome. However, its usefulness for predicting bleeding complications beyond the hospitalization period remains unknown. Our aim was to evaluate the complementary value of red cell distribution width and the CRUSADE scale to predict long-term bleeding risk in these patients.
Red cell distribution width was measured at admission in 293 patients with non-ST-segment elevation acute coronary syndrome. All patients were clinically followed up and major bleeding events were recorded (defined according to Bleeding Academic Research Consortium Definition criteria).
During a follow-up of 782 days [interquartile range, 510-1112 days], events occurred in 30 (10.2%) patients. Quartile analyses showed an abrupt increase in major bleedings at the fourth red cell distribution width quartile (> 14.9%; P=.001). After multivariate adjustment, red cell distribution width >14.9% was associated with higher risk of events (hazard ratio=2.67; 95% confidence interval, 1.17-6.10; P=.02). Patients with values ≤ 14.9% and a CRUSADE score ≤ 40 had the lowest events rate, while patients with values >14.9% and a CRUSADE score >40 points (high and very high risk) had the highest rate of bleeding (log rank test, P<.001). Further, the addition of red cell distribution width to the CRUSADE score for the prediction of major bleeding had a significant integrated discrimination improvement of 5.2% (P<.001) and a net reclassification improvement of 10% (P=.001).
In non-ST-segment elevation acute coronary syndrome patients, elevated red cell distribution width is predictive of increased major bleeding risk and provides additional information to the CRUSADE scale.
红细胞分布宽度与非ST段抬高型急性冠状动脉综合征患者住院期间出血风险增加有关。然而，其在预测住院期后出血并发症方面的作用尚不清楚。我们的目的是评估红细胞分布宽度和CRUSADE评分在预测这些患者长期出血风险方面的互补价值。
对293例非ST段抬高型急性冠状动脉综合征患者入院时测定红细胞分布宽度。所有患者均进行临床随访并记录主要出血事件（根据出血学术研究联盟定义标准定义）。
在782天的随访期内[四分位间距，510 - 1112天]，30例（10.2%）患者发生了事件。四分位数分析显示，在红细胞分布宽度第四个四分位数（>14.9%）时，主要出血事件急剧增加（P = 0.001）。多变量调整后，红细胞分布宽度>14.9%与事件风险较高相关（风险比 = 2.67；95%置信区间，1.17 - 6.10；P = 0.02）。红细胞分布宽度值≤14.9%且CRUSADE评分≤40分的患者事件发生率最低，而红细胞分布宽度值>14.9%且CRUSADE评分>40分（高风险和极高风险）的患者出血率最高（对数秩检验，P < 0.001）。此外，将红细胞分布宽度添加到CRUSADE评分中用于预测主要出血，综合判别改善显著提高了5.2%（P < 0.001），净重新分类改善为10%（P = 0.001）。
在非ST段抬高型急性冠状动脉综合征患者中，红细胞分布宽度升高可预测主要出血风险增加，并为CRUSADE评分提供额外信息。
