Díez-López Carles, Lupón Josep, de Antonio Marta, Zamora Elisabet, Domingo Mar, Santesmases Javier, Troya Maria-Isabel, Boldó Maria, Bayes-Genis Antoni
Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2016 Sep;69(9):820-6. doi: 10.1016/j.rec.2016.02.028. Epub 2016 Jun 16.
The influence of hemoglobin kinetics on outcomes in heart failure has been incompletely established.
Hemoglobin was determined at the first visit and at 6 months. Anemia was defined according to World Health Organization criteria (hemoglobin < 13g/dL for men and hemoglobin < 12g/dL for women). Patients were classified relative to their hemoglobin values as nonanemic (both measurements normal), transiently anemic (anemic at the first visit but not at 6 months), newly anemic (nonanemic initially but anemic at 6 months), or permanently anemic (anemic in both measurements).
A total of 1173 consecutive patients (71.9% men, mean age 66.8±12.2 years) were included in the study. In all, 476 patients (40.6%) were considered nonanemic, 170 (14.5%) had transient anemia, 147 (12.5%) developed new-onset anemia, and 380 (32.4%) were persistently anemic. During a follow-up of 3.7±2.8 years after the 6-month visit, 494 patients died. On comprehensive multivariable analyses, anemia (P < .001) and the type of anemia (P < .001) remained as independent predictors of all-cause mortality. Compared with patients without anemia, patients with persistent anemia (hazard ratio [HR] = 1.62; 95% confidence interval [95%CI], 1.30-2.03; P < .001) and new-onset anemia (HR = 1.39; 95%CI, 1.04-1.87, P = .03) had higher mortality, and even transient anemia showed a similar trend, although without reaching statistical significance (HR = 1.31; 95%CI, 0.97-1.77, P = .075).
Anemia, especially persistent and of new-onset, and to a lesser degree, transient anemia, is deleterious in heart failure.
血红蛋白动力学对心力衰竭预后的影响尚未完全明确。
在首次就诊时及6个月时测定血红蛋白。根据世界卫生组织标准定义贫血（男性血红蛋白<13g/dL，女性血红蛋白<12g/dL）。根据患者的血红蛋白值将其分类为非贫血（两次测量均正常）、短暂性贫血（首次就诊时贫血但6个月时不贫血）、新发贫血（最初非贫血但6个月时贫血）或持续性贫血（两次测量均贫血）。
共纳入1173例连续患者（男性占71.9%，平均年龄66.8±12.2岁）。总体而言，476例患者（40.6%）被认为非贫血，170例（14.5%）有短暂性贫血，147例（12.5%）出现新发贫血，380例（32.4%）为持续性贫血。在6个月就诊后的3.7±2.8年随访期间，494例患者死亡。经过全面的多变量分析，贫血（P<.001）和贫血类型（P<.001）仍然是全因死亡率的独立预测因素。与无贫血患者相比，持续性贫血患者（风险比[HR]=1.62；95%置信区间[95%CI]，1.30 - 2.03；P<.001）和新发贫血患者（HR = 1.39；95%CI，1.04 - 1.87，P =.03）的死亡率更高，即使是短暂性贫血也显示出类似趋势，尽管未达到统计学意义（HR = 1.31；95%CI，0.97 - 1.77，P =.075）。
贫血，尤其是持续性贫血和新发贫血，以及程度较轻的短暂性贫血，在心力衰竭中是有害的。
