Irzmański Robert, Kapusta Joanna, Obrębska-Stefaniak Agnieszka, Urzędowicz Beata, Kowalski Jan
Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Poland.
Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Kościuszki 4, Lodz 90-419, Poland.
Ther Adv Cardiovasc Dis. 2017 Jul;11(7):177-184. doi: 10.1177/1753944717706845. Epub 2017 May 29.
The prognosis in patients after acute coronary syndromes (ACS) is significantly burdened by coexisting anaemia, leukocytosis and low glomerular filtration rate (GFR). Hyperglycaemia in the early stages of ACS is a strong predictor of death and heart failure in non-diabetic subjects. This study aimed to evaluate the effect of hyperglycaemia, anaemia, leukocytosis, thrombocytopaenia and decreased GFR on the risk of the failure of cardiac rehabilitation (phase II at the hospital) in post-ST-segment elevation myocardial infarction (STEMI) patients.
The study included 136 post-STEMI patients, 96 men and 40 women, aged 60.1 ± 11.8 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz, Poland. On admission fasting blood cell count was performed and serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose ⩾ 100 mg/dl, GFR < 60 ml/min/1, 73 m², red blood cells (RBCs) < 4 × 106/μl, white blood cells (WBCs) > 10 × 103/μl; platelets (PLTs) < 150 × 10³/ml. In all patients an exercise test was performed twice, before and after the completion of the second stage of rehabilitation, to assess its effects.
Based on logistic regression analysis and the results of an individual odds ratio (OR) of the tested parameters, their prognostic impact was determined on the risk of failure of cardiac rehabilitation. This risk has been defined on the basis of the patient's inability to tolerate workload increment >5 Watt in spite of the applied program of cardiac rehabilitation. As a result of building a logistic regression model, the most statistically significant risk factors were selected, on the basis of which cardiac rehabilitation failure index was determined. leukocytosis and reduced GFR determined most significantly the risk of failure of cardiac rehabilitation (respectively OR = 6.42 and OR = 3.29, p = 0.007). These parameters were subsequently utilized to construct a rehabilitation failure index.
Peripheral blood cell count and GFR are important in assessing the prognosis of cardiac rehabilitation effects. leukocytosis and decreased GFR determine to the highest degree the risk of cardiac rehabilitation failure. Cardiac rehabilitation failure index may be useful in classifying patients into an appropriate model of rehabilitation. These findings support our earlier reports.
急性冠状动脉综合征（ACS）患者的预后受到并存的贫血、白细胞增多和低肾小球滤过率（GFR）的显著影响。ACS早期的高血糖是无糖尿病患者死亡和心力衰竭的有力预测指标。本研究旨在评估高血糖、贫血、白细胞增多、血小板减少和GFR降低对ST段抬高型心肌梗死（STEMI）患者心脏康复（医院二期）失败风险的影响。
该研究纳入了136例STEMI后患者，其中96例男性和40例女性，年龄60.1±11.8岁，因心脏康复（二期）入住波兰罗兹瓦姆大学医院内科与心脏康复科。入院时进行空腹血细胞计数，并测定血清葡萄糖和肌酐水平（评估GFR）。以下结果被视为异常：血糖⩾100mg/dl、GFR<60ml/min/1.73m²、红细胞（RBC）<4×10⁶/μl、白细胞（WBC）>10×10³/μl；血小板（PLT）<150×10³/ml。所有患者在康复第二阶段前后各进行一次运动试验，以评估其效果。
基于逻辑回归分析和所测参数的个体比值比（OR）结果，确定了它们对心脏康复失败风险的预后影响。该风险是根据患者尽管接受了心脏康复计划但仍无法耐受工作量增加>5瓦特来定义的。通过构建逻辑回归模型，选择了统计学上最显著的风险因素，并据此确定了心脏康复失败指数。白细胞增多和GFR降低最显著地决定了心脏康复失败的风险（OR分别为6.42和3.29，p=0.007）。随后利用这些参数构建了康复失败指数。
外周血细胞计数和GFR对评估心脏康复效果的预后很重要。白细胞增多和GFR降低在很大程度上决定了心脏康复失败的风险。心脏康复失败指数可能有助于将患者分类到合适的康复模式中。这些发现支持了我们早期的报告。
