Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland.
Kardiol Pol. 2019;77(3):347-354. doi: 10.5603/KP.a2019.0014. Epub 2019 Feb 11.
We believe that there is a physiological link between intracellular iron status (assessed by soluble transferrin receptor [sTfR]) and efficiency of energy production/consumption (assessed by lactate, a product of anaerobic cell metabolism), which may further impact the outcome of patients with acute heart failure (AHF).
To examine if elevated levels of lactate (> 2 mmol/L) accompanied by unmet cellular iron requirements (defined as sTfR > 1.59 mg/L) identify AHF patients with an unfavourable outcome.
The study is a single-centre, retrospective analysis of AHF patients in whom lactate and iron status were assessed on admission. The endpoint of the study was one-year mortality.
The study population consisted of 89 patients at a mean age of 65 ± 13 years. Mean systolic blood pressure and creatinine level were 135 ± 36 mmHg and 1.3 ± 0.6 mg/dL, respectively, and median [25th-75th quartiles] lactate level on admission was 2.0 [1.6-2.6] mmol/L. In 17 (19%) patients, both lactate and sTfR were below the cut-off values (group 1). In 38 (43%) individuals one of the markers was elevated (group 2) and in the remaining 34 (38%) patients both markers were above the predefined cut-off values (group 3). There was no difference in clinical and laboratory characteristics between the groups. During one-year follow-up 23 (26%) patients died. Mortality risk in group 3 was higher compared to the rest of the population (hazard ratio 5.6, 95% confidence interval 2.2-14, p = 0.0003), even after adjustments for well-defined prognostic factors.
Patients with unmet iron cell requirements and hyperlactataemia on admission have significantly higher mortality risk compared to individuals without those pathologies.
我们认为细胞内铁状态（通过可溶性转铁蛋白受体[sTfR]评估）与能量产生/消耗效率（通过乳酸评估，这是无氧细胞代谢的产物）之间存在生理联系，这可能进一步影响急性心力衰竭（AHF）患者的结局。
检查入院时乳酸水平升高（> 2mmol/L）且存在未满足的细胞铁需求（定义为 sTfR > 1.59mg/L）是否能识别出 AHF 患者的不良预后。
这是一项单中心、回顾性分析，纳入了入院时评估乳酸和铁状态的 AHF 患者。研究终点为一年死亡率。
研究人群由 89 名年龄 65±13 岁的患者组成。平均收缩压和肌酐水平分别为 135±36mmHg 和 1.3±0.6mg/dL，入院时中位数[25 至 75 百分位数]乳酸水平为 2.0[1.6-2.6]mmol/L。在 17 名（19%）患者中，乳酸和 sTfR 均低于临界值（组 1）。在 38 名（43%）个体中，有一种标志物升高（组 2），而在其余 34 名（38%）患者中，两种标志物均高于预设的临界值（组 3）。三组之间的临床和实验室特征无差异。在一年随访期间，23 名（26%）患者死亡。与其余人群相比，组 3 的死亡风险更高（危险比 5.6，95%置信区间 2.2-14，p = 0.0003），即使在调整了明确的预后因素后也是如此。
入院时存在未满足的铁细胞需求和高乳酸血症的患者与不存在这些病理的患者相比，死亡率风险显著增加。
