Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Okan University Hospital, Istanbul, Turkey.
Eur J Clin Invest. 2021 Aug;51(8):e13550. doi: 10.1111/eci.13550. Epub 2021 Mar 29.
Patients with heart failure with reduced ejection fraction (HFrEF) who received implantable cardiac defibrillator (ICD) still remain at high risk due to pump failure and prevalent comorbid conditions. The primary aim of this research was to evaluate the predictive value of C-reactive protein-to-albumin ratio (CAR) for all-cause mortality among patients with HFrEF despite ICD implantation.
Those who were implanted ICD for HFrEF in our institution between 2009 and 2019 were included. Data were extracted from hospital's database. CAR was calculated as ratio of C-reactive protein (CRP) to serum albumin concentration. Patients were grouped into tertiles in accordance with CAR at the time of the implantation. During follow-up duration of 38 [17-77] months, survival times of tertiles were compared by using Kaplan-Meier survival method. Forward Cox proportional regression model was used for multivariable analysis.
Thousand and eleven patients constituted the study population. Ischaemic cardiomyopathy was the primary diagnosis in 92.3%, and ICD was implanted for the primary prevention among 33.9% of patients. Of those, 14.5% died after the discharge. Patients in tertile 3 (T3) had higher risk of mortality (4.2% vs 11.0% vs 28.5%) compared with those in other tertiles. Multivariable analysis revealed that when patients in T1 were considered as the reference, both those in T2 and those in T3 had independently higher risk of all-cause mortality. This finding was consistent in the unadjusted and adjusted multivariable models.
Among patients with HFrEF and ICD, elevated CAR increased the risk of all-cause mortality at long term.
接受植入式心脏除颤器 (ICD) 的射血分数降低型心力衰竭 (HFrEF) 患者仍存在泵衰竭和普遍共存疾病的高风险。本研究的主要目的是评估 C 反应蛋白与白蛋白比值 (CAR) 对 HFrEF 患者尽管植入 ICD 但仍发生全因死亡率的预测价值。
纳入 2009 年至 2019 年在我院植入 ICD 的 HFrEF 患者。数据从医院数据库中提取。CAR 计算为 C 反应蛋白 (CRP) 与血清白蛋白浓度的比值。根据植入时 CAR 将患者分为三组。在 38 [17-77] 个月的随访期间，采用 Kaplan-Meier 生存法比较三组的生存时间。采用向前 Cox 比例风险回归模型进行多变量分析。
本研究共纳入 1101 例患者。92.3%的患者主要诊断为缺血性心肌病，33.9%的患者植入 ICD 为一级预防。其中，出院后有 14.5%的患者死亡。与其他两组相比，CAR 较高的 T3 组患者死亡率较高（4.2% vs 11.0% vs 28.5%）。多变量分析显示，当 T1 组患者作为参考时，T2 组和 T3 组患者发生全因死亡的风险均独立升高。这一发现无论是在未调整的还是调整后的多变量模型中均一致。
在 HFrEF 和 ICD 患者中，CAR 升高增加了长期全因死亡率的风险。
