Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain.
Servicio de Medicina Interna. Hospital Universitario Ramón Y Cajal, Madrid, Spain.
Clin Res Cardiol. 2021 Aug;110(8):1292-1298. doi: 10.1007/s00392-021-01832-z. Epub 2021 Mar 15.
For patients with heart failure (HF), iron deficiency (ID) is a common therapeutic target. However, little is known about the utility of transferrin saturation (TSAT) or serum ferritin for risk stratification in decompensated HF (DHF) or the European Society of Cardiology's (ESC) current definition of ID (ferritin < 100 μg/L or TSAT < 20% if ferritin is 100-299 μg/L). We evaluated the association between these potential markers of ID and the risk of 30-day readmission for HF or death in patients with DHF.
We retrospectively included 1701 patients from a multicenter registry of DHF. Serum ferritin and TSAT were evaluated 24-72 h after hospital admission, and multivariable Cox regression was used to assess their association with the composite endpoint.
Participants' median (quartiles) age was 76 (68-82) years, 43.8% were women, and 51.7% had a left ventricular ejection fraction > 50%. Medians for NT-proBNP, TSAT, and ferritin were 4067 pg/mL (1900-8764), 14.1% (9.0-20.3), and 103 ug/L (54-202), respectively. According to the current ESC definition, 1,246 (73.3%) patients had ID. By day 30, there were 177 (10.4%) events (95 deaths and 85 HF readmission). After multivariable adjustment, lower TSAT was associated with outcome (p = 0.009) but serum ferritin was not (HR 1.00; 95% confidence interval 0.99-1.00, p = 0.347).
Lower TSAT, but not ferritin, was associated with a higher risk of short-term events in patients with DHF. Further research is needed to confirm these findings and the utility of serum ferritin as a marker of ID in DHF.
对于心力衰竭（HF）患者，铁缺乏（ID）是常见的治疗靶点。然而，对于转铁蛋白饱和度（TSAT）或血清铁蛋白在失代偿性 HF（DHF）中的风险分层的作用，以及欧洲心脏病学会（ESC）目前对 ID 的定义（铁蛋白<100μg/L 或铁蛋白为 100-299μg/L 时 TSAT<20%）知之甚少。我们评估了这些潜在 ID 标志物与 DHF 患者 30 天内 HF 再入院或死亡风险之间的关系。
我们回顾性纳入了来自 DHF 多中心登记处的 1701 例患者。入院后 24-72 小时评估血清铁蛋白和 TSAT，使用多变量 Cox 回归评估它们与复合终点的关系。
参与者的中位（四分位数）年龄为 76（68-82）岁，43.8%为女性，51.7%的左心室射血分数>50%。NT-proBNP、TSAT 和铁蛋白的中位数分别为 4067pg/mL（1900-8764）、14.1%（9.0-20.3）和 103μg/L（54-202）。根据 ESC 的现行定义，1246 例（73.3%）患者存在 ID。在第 30 天，有 177 例（95 例死亡，85 例 HF 再入院）事件。经过多变量调整，较低的 TSAT 与结局相关（p=0.009），但血清铁蛋白则不然（HR 1.00；95%置信区间 0.99-1.00，p=0.347）。
在 DHF 患者中，较低的 TSAT，而不是铁蛋白，与短期事件的风险增加相关。需要进一步的研究来证实这些发现，并确定血清铁蛋白作为 DHF 中 ID 的标志物的效用。
