Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
Department of Cardiovascular Medicine, University Hospital of Freiburg, Bad Krozingen, Germany.
Eur J Intern Med. 2016 Jun;31:62-7. doi: 10.1016/j.ejim.2016.03.002. Epub 2016 Mar 22.
Evident data about the additive effect of "the fifth cardiovascular risk factor" (anemia) and peripheral arterial disease (PAD) focused on morbidity and outcome of patients with PAD are currently still missing.
A total of 41,882 PAD patients were included. Of these, 5566 (13.3%) suffered from anemia. Patients with anemia were older (P<0.001), suffered more often from chronic kidney disease (P<0.001), coronary artery disease (P<0.001), and more severe PAD (P<0.001). However, they received significantly less endovascular revascularizations (P<0.001), had higher amputation rates (acute anemia: 3.7-fold, P<0.001; nutritional, aplastic, and anemia in chronic disease: 2.9-fold, P<0.001), higher in-hospital mortality rates (acute anemia: 6.4-fold, P<0.001; nutritional, aplastic, and anemia in chronic disease: 4.6-fold; P<0.001), had significantly higher in-hospital complications (P<0.001) compared to those without anemia. During a follow-up time up to 4years (until Dec. 31st, 2012, median 775days, 25th-75th percentiles 469-1120days) nutritional, aplastic, and anemia in chronic disease and acute anemia were high significant predictors of long-term mortality and amputation (each P<0.001). Lengths of hospital stay and reimbursement costs were higher (nutritional, aplastic, and anemia in chronic disease: 2-fold higher (P<0.001), acute anemia: 3-fold higher (P<0.001)) than in patients without anemia.
This study illustrates from a large, comprehensive database the association of acute, nutritional, aplastic, and anemia in chronic disease on morbidity, in-hospital treatment and complications, short- and long term outcome, and costs of patients with PAD.
目前关于“第五大心血管风险因素”（贫血）和外周动脉疾病（PAD）的附加效应的明确数据主要集中在 PAD 患者的发病率和结局方面。
共纳入 41882 例 PAD 患者。其中，5566 例（13.3%）患有贫血。贫血患者年龄更大（P<0.001），更常患有慢性肾脏病（P<0.001）、冠状动脉疾病（P<0.001）和更严重的 PAD（P<0.001）。然而，他们接受的血管内血运重建术明显较少（P<0.001），截肢率更高（急性贫血：3.7 倍，P<0.001；营养性、再生障碍性和慢性病贫血：2.9 倍，P<0.001），住院死亡率更高（急性贫血：6.4 倍，P<0.001；营养性、再生障碍性和慢性病贫血：4.6 倍，P<0.001），住院并发症显著更多（P<0.001）与无贫血患者相比。在长达 4 年的随访期间（截至 2012 年 12 月 31 日，中位随访时间为 775 天，25-75%分位数为 469-1120 天），营养性、再生障碍性和慢性病贫血以及急性贫血是长期死亡率和截肢的显著预测因素（均 P<0.001）。住院时间和报销费用更高（营养性、再生障碍性和慢性病贫血：高 2 倍（P<0.001），急性贫血：高 3 倍（P<0.001））比没有贫血的患者。
这项来自大型综合数据库的研究说明了急性、营养性、再生障碍性和慢性病贫血对 PAD 患者的发病率、住院治疗和并发症、短期和长期结局以及成本的影响。
