急性冠状动脉综合征患者的红细胞分布宽度与死亡率：一项关于预后的荟萃分析

Red Cell Distribution Width and Mortality in Patients With Acute Coronary Syndrome: A Meta-Analysis on Prognosis.

作者信息

Abrahan Lauro L, Ramos John Daniel A, Cunanan Elleen L, Tiongson Marc Denver A, Punzalan Felix Eduardo R

机构信息

Section of Cardiology, University of the Philippines, Philippine General Hospital, Manila Philippines 1000, Philippines.

出版信息

Cardiol Res. 2018 Jun;9(3):144-152. doi: 10.14740/cr732w. Epub 2018 Jun 6.

BACKGROUND

Red cell distribution width (RDW), a routine component of the complete blood count (CBC), measures variation in the size of circulating erythrocytes. It has been associated with several clinical outcomes in cardiovascular disease. We sought to strengthen the association between RDW and mortality in patients admitted for acute coronary syndrome (ACS) by pooling together data from available studies.

METHODS

Studies that fulfilled the following were identified for analysis: 1) observational; 2) included patients admitted for ACS; 3) reported data on all-cause or cardiovascular (CV) mortality in association with a low or high RDW; and 4) used logistic regression analysis to control for confounders. Using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases, a search for eligible studies was conducted until January 9, 2017. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Our primary outcome of interest was all-cause or CV mortality. We also investigated the impact of RDW on major adverse cardiovascular events (MACEs) for the studies that reported these outcomes. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk.

RESULTS

We identified 13 trials involving 10,410 patients, showing that in ACS, a low RDW is associated with a statistically significant lower all-cause or CV mortality (RR 0.35, (95% CI 0.30 to 0.40), P < 0.00001, I = 53%), a finding that was consistent both in the short- and long-term.

CONCLUSIONS

A low RDW is also associated with lower risk for MACEs after an ACS (RR 0.56, (95% CI 0.51 to 0.61), P < 0.00001, I = 91%). A low RDW during an ACS is associated with lower all-cause or CV mortality and lower risk of subsequent MACEs, providing us with a convenient and inexpensive risk stratification tool in ACS patients.

背景

红细胞分布宽度（RDW）是全血细胞计数（CBC）的常规组成部分，用于测量循环红细胞大小的变化。它与心血管疾病的多种临床结局相关。我们试图通过汇总现有研究的数据，加强急性冠状动脉综合征（ACS）患者中RDW与死亡率之间的关联。

方法

确定符合以下条件的研究进行分析：1）观察性研究；2）纳入因ACS入院的患者；3）报告低或高RDW与全因或心血管（CV）死亡率相关的数据；4）使用逻辑回归分析控制混杂因素。利用MEDLINE、Clinical Key、ScienceDirect、Scopus和Cochrane对照试验中央注册库数据库，检索符合条件的研究，直至2017年1月9日。使用纽卡斯尔-渥太华质量评估量表评估每项研究的质量。我们感兴趣的主要结局是全因或CV死亡率。我们还调查了RDW对报告这些结局的研究中主要不良心血管事件（MACE）的影响。使用Review Manager（RevMan）5.3进行随机效应的Mantel-Haenzel分析并计算相对风险。