红细胞分布宽度是射血分数降低的稳定的、药物治疗优化的心力衰竭门诊患者贫血和N末端B型利钠肽原之外的生存预测指标。

Red blood cell distribution width is a survival predictor beyond anemia and Nt-ProBNP in stable optimally medicated heart failure with reduced ejection fraction outpatients.

作者信息

Sargento Luis, Simões Andre Vicente, Longo Susana, Lousada Nuno, Palma Dos Reis Roberto

出版信息

Clin Hemorheol Microcirc. 2017;65(2):185-194. doi: 10.3233/CH-16155.

DOI:10.3233/CH-16155

PMID:27716652

Abstract

BACKGROUND

RDW is an automatic value obtained with the blood count, and represents the erythrocytes dimension variation.

OBJECTIVE

To evaluate in optimally medicated outpatients with heart failure with reduced ejection fraction (HFrEF) the RDW prognostic value regarding survival in a multivariable model including anemia and Nt-ProBNP.

METHODS

233 consecutive outpatients, LVEF <40%, clinically stable were followed-up for 3-years in an HF Unit. End-point was all-cause death. The RDW categorized according to the tertiles (T1 = <13.9; T2 14-15.2; T3> = 15.3). Anemia classified according to the WHO criteria. Cox survival model adjusted for clinical profile, optimal therapeutic, renal function, Nt-ProBNP, etiology, atrial fibrillation, and anemia.

RESULTS

(1) The 3-years death rate was 33.5%, and increased with the RDW tertiles (17.3%; 25%; 61.1%; p < 0.001). (2) The ROC curve for death associated with RDW (AUC 0.73; p < 0.001); (3) The adjusted death risk increased with the tertiles (Hazard-ratio '[HR] = 1.61; IC 95% 1.09-2.39; p = 0.017). RDW> = 15.3 had greater adjusted death risk than T1 (HR = 2.18; 95% CI 0.99-4.8; p = 0.05) and T1+T2 (HR = 1.54; 95% CI 1.13-2.09; p = 0.006).

CONCLUSION

RDW determined in optimally medicated outpatients with HFrEF, during dry-state, is a strong, cheap, and independent predictor of long-term survival.

摘要

背景

红细胞分布宽度（RDW）是通过血细胞计数获得的一个自动值，代表红细胞大小的变化。

目的

在射血分数降低的心力衰竭（HFrEF）最佳药物治疗的门诊患者中，评估在包含贫血和N末端脑钠肽前体（Nt-ProBNP）的多变量模型中RDW对生存的预后价值。

方法

233例连续的门诊患者，左心室射血分数（LVEF）<40%，临床稳定，在心力衰竭病房进行了3年随访。终点为全因死亡。RDW根据三分位数分类（T1 = <13.9；T2 = 14 - 15.2；T3 >= 15.3）。贫血根据世界卫生组织标准分类。Cox生存模型根据临床特征、最佳治疗、肾功能、Nt-ProBNP、病因、心房颤动和贫血进行校正。

结果

（1）3年死亡率为33.5%，且随RDW三分位数增加（17.3%；25%；61.1%；p < 0.001）。（2）与RDW相关的死亡的ROC曲线（曲线下面积[AUC] = 0.73；p < 0.001）；（3）校正后的死亡风险随三分位数增加（风险比[HR] = 1.61；95%置信区间[IC] 1.09 - 2.39；p = 0.017）。RDW >= 15.3的校正死亡风险高于T1（HR = 2.18；95%置信区间0.99 - 4.8；p = 0.05）和T1 + T2（HR = 1.54；95%置信区间1.13 - 2.09；p = 0.006）。