Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
Saiseikai Toyama Hospital, Toyama, Japan.
Int J Cardiol. 2020 Mar 1;302:81-87. doi: 10.1016/j.ijcard.2019.11.127. Epub 2019 Nov 22.
To clarify the influence of hemoglobin concentration and platelet count on adverse outcomes of Japanese patients with non-valvular atrial fibrillation (NVAF), a post hoc analysis of the J-RHYTHM Registry was performed.
A consecutive series of outpatients with atrial fibrillation were enrolled from 158 institutions and followed up for 2 years or until an event occurred (thromboembolism, major hemorrhage, or all-cause death). Among 7406 patients with NVAF, 6536 with complete blood count data (69.8 ± 9.9 years, 71.0% men) were divided into 4 groups according to the baseline hemoglobin level (<10.0, 10.0-11.9, 12.0-13.9, and ≥14.0 g/dL) or platelet count (<10.0, 10.0-19.9, 20.0-29.9, and ≥30.0 × 10/μL).
Incidence rates of major hemorrhage (p = 0.004 for trend), all-cause death (p < 0.001 for trend), and composite events (p < 0.001 for trend) increased as hemoglobin levels decreased, and composite events (p = 0.045 for trend) increased as platelet counts decreased. After adjusting for multiple confounders, the incidence of all-cause death and composite events was higher with hemoglobin levels <12.0 g/dL than a hemoglobin level ≥14.0 g/dL. In contrast, platelet count was not associated with any events. This was also true when multivariate analysis was performed using the stepwise forward method.
A low hemoglobin level (<12.0 g/dL) was an independent risk factor for all-cause death and composite events in Japanese patients with NVAF. However, platelet count did not impact outcomes.
http://www.umin.ac.jp/ctr/ (unique identifier: UMIN000001569).
为了阐明血红蛋白浓度和血小板计数对日本非瓣膜性心房颤动（NVAF）患者不良结局的影响，对 J-RHYTHM 登记处进行了事后分析。
从 158 家机构连续招募了一系列房颤门诊患者，并进行了 2 年的随访或直至发生事件（血栓栓塞、大出血或全因死亡）。在 7406 例 NVAF 患者中，有 6536 例具有完整的全血细胞计数数据（69.8±9.9 岁，71.0%为男性），根据基线血红蛋白水平（<10.0、10.0-11.9、12.0-13.9 和≥14.0 g/dL）或血小板计数（<10.0、10.0-19.9、20.0-29.9 和≥30.0×10/μL）分为 4 组。
随着血红蛋白水平的降低，大出血（趋势 p=0.004）、全因死亡（趋势 p<0.001）和复合事件（趋势 p<0.001）的发生率增加，随着血小板计数的降低，复合事件（趋势 p=0.045）的发生率增加。在校正了多个混杂因素后，血红蛋白水平<12.0 g/dL 的全因死亡和复合事件发生率高于血红蛋白水平≥14.0 g/dL。相反，血小板计数与任何事件均无关。使用逐步向前法进行多变量分析时也是如此。
低血红蛋白水平（<12.0 g/dL）是日本 NVAF 患者全因死亡和复合事件的独立危险因素。然而，血小板计数对结果没有影响。
