Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Hematology, University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
Int J Cardiol. 2019 Jul 1;286:104-110. doi: 10.1016/j.ijcard.2019.02.060. Epub 2019 Feb 27.
Relative hypochromia of erythrocytes defined as a reduced mean corpuscular hemoglobin concentration (MCHC) is a surrogate of iron deficiency. We aimed to evaluate the prevalence and prognostic impact of relative hypochromia in acute heart failure (AHF).
We prospectively characterized 1574 patients presenting with an adjudicated diagnosis of AHF to the emergency department. Relative hypochromia was defined as a MCHC ≤330 g/l and determined at presentation. The presence of AHF was adjudicated by two independent cardiologists. All-cause mortality and AHF-rehospitalization were the primary prognostic end-points.
Overall, 455 (29%) AHF patients had relative hypochromia. Patients with relative hypochromia had higher hemodynamic cardiac stress as quantified by NT-proBNP concentrations (p < 0.001), more extensive cardiomyocyte injury as quantified by high-sensitive cardiac troponin T (hs-cTnT) concentrations (p < 0.001), and lower estimated glomerular filtration rate (eGFR; p < 0.001) as compared to AHF patients without hypochromia. Cumulative incidences for all-cause mortality and AHF-rehospitalization at 720-days were 50% and 55% in patients with relative hypochromia as compared to 33% and 39% in patients without hypochromia, respectively (both p < 0.0001). The association between relative hypochromia and increased mortality (HR 1.7, 95% CI 1.4-2-0) persisted after adjusting for anemia (HR 1.5, 95% CI 1.3-1.8), and after adjusting for hemodynamic cardiac stress (HR 1.46, 95% CI 1.21-1.76) and eGFR (HR 1.5, 95% CI 1.3-1.8, p < 0.001).
Relative hypochromia is common and a strong and independent predictor of increased mortality in AHF. Given the direct link to diagnostic (endoscopy) and therapeutic interventions to treat functional iron deficiency, relative hypochromia deserves increased attention as an inexpensive and universally available biomarker.
红细胞相对低色素定义为平均红细胞血红蛋白浓度（MCHC）降低，是铁缺乏的替代指标。我们旨在评估急性心力衰竭（AHF）中相对低色素的患病率和预后影响。
我们前瞻性地描述了 1574 名因经判定的 AHF 而就诊于急诊部的患者。相对低色素定义为 MCHC≤330g/l，并在就诊时确定。AHF 的存在由两名独立的心脏病专家判定。全因死亡率和 AHF 再入院是主要的预后终点。
总体而言，455（29%）名 AHF 患者存在相对低色素。与无低色素的 AHF 患者相比，相对低色素的患者具有更高的血液动力学心脏应激，如 NT-proBNP 浓度所示（p<0.001），更广泛的心肌细胞损伤，如高敏心肌肌钙蛋白 T（hs-cTnT）浓度所示（p<0.001），和更低的估算肾小球滤过率（eGFR；p<0.001）。在 720 天的时间内，相对低色素患者的全因死亡率和 AHF 再入院的累积发生率分别为 50%和 55%，而无低色素的患者分别为 33%和 39%（均 p<0.0001）。在调整贫血（HR 1.5，95%CI 1.3-1.8）和调整血液动力学心脏应激（HR 1.46，95%CI 1.21-1.76）和 eGFR（HR 1.5，95%CI 1.3-1.8，p<0.001）后，相对低色素与死亡率增加之间的关联仍然存在。
相对低色素很常见，是 AHF 患者死亡率增加的一个强烈且独立的预测指标。鉴于其与诊断（内镜）和治疗铁缺乏症的干预措施直接相关，相对低色素作为一种廉价且普遍可用的生物标志物，值得进一步关注。
