Chair of Cardiology, University of Eastern Piedmont and Maggiore della Carità Hospital, Novara, Italy.
Department of Medicine and Ageing Sciences, "G. d'Annunzio" University, Chieti, Italy.
Eur J Clin Invest. 2021 Aug;51(8):e13562. doi: 10.1111/eci.13562. Epub 2021 May 7.
The identification of novel predictors of poor outcome may help stratify cardiovascular risk. Aim was to evaluate the individual contribution of blood cell count parameters, as well as their clustering, on the risk of death and cardiovascular events over the long term in the population-based Malmö Diet and Cancer Study cohort.
In 30,447 individuals (age 57 ± 8 years), we assessed the incidence of all-cause death (primary endpoint) and major adverse cardiovascular events (MACE, secondary outcome measure) according to absence or presence of one, two and three factors at baseline out of the following: anaemia, leukocytosis and thrombocytosis. Median follow-up was 16 years.
The percentages of all-cause death were 19.5% in individuals without factors, 21.3% in those with one factor, 27.4% with two and 46.4% with three (log-rank test P < .001). The crude incidence of MACE was 28.0%, 29.2%, 35.5% and 57.1%, respectively (log-rank test P < .001). At multivariate analysis, we found a stepwise increase in overall mortality with increasing number of prevalent factors (one factor: HR 1.23, 95% CI 1.14-1.31, P < .001; two factors: 1.61, 1.37-1.89, P < .001; three factors: 2.69, 1.44-5.01, P = .002, vs no factor). Similar findings were observed for the incidence of MACE (one factor: adjusted HR 1.18, 95% CI 1.11-1.24, P < .001; two factors: 1.52, 1.33-1.76, P < .001; three factors: 2.03, 1.21-3.67, P < .001, vs no factor).
The easily assessable clustering of anaemia, leukocytosis and thrombocytosis heralds higher incidence of death and adverse cardiovascular events.
识别新的预后不良预测因子有助于分层心血管风险。目的是评估在基于人群的马尔默饮食与癌症研究队列中，血细胞计数参数的个体贡献及其聚类对长期全因死亡和心血管事件风险的影响。
在 30447 名（年龄 57±8 岁）个体中，我们根据基线时是否存在以下一个、两个和三个因素评估全因死亡（主要终点）和主要不良心血管事件（次要终点测量）的发生率：贫血、白细胞增多和血小板增多。中位随访时间为 16 年。
无上述因素者的全因死亡率为 19.5%，有一个因素者为 21.3%，有两个因素者为 27.4%，有三个因素者为 46.4%（对数秩检验 P<0.001）。未校正的 MACE 发生率分别为 28.0%、29.2%、35.5%和 57.1%（对数秩检验 P<0.001）。多变量分析发现，随着现患因素数量的增加，总死亡率呈逐步增加趋势（一个因素：HR 1.23，95%CI 1.14-1.31，P<0.001；两个因素：1.61，1.37-1.89，P<0.001；三个因素：2.69，1.44-5.01，P=0.002，与无因素相比）。同样的发现也见于 MACE 的发生率（一个因素：校正 HR 1.18，95%CI 1.11-1.24，P<0.001；两个因素：1.52，1.33-1.76，P<0.001；三个因素：2.03，1.21-3.67，P<0.001，与无因素相比）。
贫血、白细胞增多和血小板增多的易评估聚类预示着更高的死亡率和不良心血管事件发生率。
