Cardiology, Concord Repatriation General Hospital, The University of Sydney, Concord, New South Wales, Australia.
BMJ Open. 2019 May 1;9(4):e027112. doi: 10.1136/bmjopen-2018-027112.
Anaemia is associated with increased mortality in acute pulmonary embolism (PE) patients. However, prior studies have not examined the prognostic impact of trends in plasma haemoglobin during admission. This study investigates the impact of changes in haemoglobin level on mortality during hospital stay in acute PE.
A retrospective observational study.
Tertiary-referral centre in Australia.
Consecutive patients from 2000 to 2012 admitted with confirmed acute PE were identified from a dedicated PE database. Haemoglobin levels on days 1, 3-4, 5-6 and 7 of admission were retrieved. Patients without both baseline haemoglobin and subsequent haemoglobin levels were excluded (n=327), leaving 1099 patients as the study cohort. Anaemia was defined as haemoglobin <130 g/L for men and <120 g/L for women. There were 576 patients without anaemia throughout admission, 65 with transient anaemia (anaemic on day 1, but subsequently normalised during admission), 122 with acquired anaemia (normal on day 1 but developed anaemia during admission) and 336 with persistent anaemia. A total of 71 patients received blood transfusion during admission.
6-month mortality was tracked from a state-wide death database and analysed using multivariable modelling.
After adjusting for transfusion, patietns with persistent anaemia had a significantly increased 6-month mortality risk (adjusted HR 1.97, 95% CI 1.26 to 3.09, p=0.003) compared with patients without anaemia. There was no difference in mortality between patients with transient or acquired anaemia and patients without anaemia.
Among patients who had anaemia during their admission for acute PE, only the subgroup with persistent anaemia demonstrated worse outcomes.
贫血与急性肺栓塞（PE）患者的死亡率增加相关。然而，先前的研究并未检查入院期间血浆血红蛋白趋势的预后影响。本研究调查了急性 PE 住院期间血红蛋白水平变化对死亡率的影响。
回顾性观察性研究。
澳大利亚的三级转诊中心。
从专门的 PE 数据库中确定了 2000 年至 2012 年期间因确诊的急性 PE 入院的连续患者。检索了入院第 1、3-4、5-6 和 7 天的血红蛋白水平。排除了既无基线血红蛋白又无后续血红蛋白水平的患者（n=327），留下 1099 名患者作为研究队列。贫血定义为男性血红蛋白<130g/L，女性血红蛋白<120g/L。在整个住院期间，有 576 名患者无贫血，65 名患者出现短暂性贫血（第 1 天贫血，但在住院期间恢复正常），122 名患者出现获得性贫血（第 1 天正常，但在住院期间出现贫血），336 名患者出现持续性贫血。共有 71 名患者在住院期间接受了输血。
从全州死亡数据库中跟踪 6 个月死亡率，并使用多变量模型进行分析。
调整输血后，与无贫血患者相比，持续性贫血患者的 6 个月死亡率显著增加（调整后的 HR 1.97，95%CI 1.26 至 3.09，p=0.003）。与无贫血患者相比，有短暂性或获得性贫血的患者的死亡率没有差异。
在因急性 PE 住院期间有贫血的患者中，只有持续性贫血亚组的预后更差。
