Ndrepepa Gjin, Neumann Franz-Josef, Menichelli Maurizio, Holdenrieder Stefan, Richardt Gert, Mayer Katharina, Cassese Salvatore, Xhepa Erion, Kufner Sebastian, Wiebe Jens, Joner Michael, Kessler Thorsten, Laugwitz Karl Ludwig, Schunkert Heribert, Kastrati Adnan
Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany.
Eur J Clin Invest. 2021 Dec;51(12):e13670. doi: 10.1111/eci.13670. Epub 2021 Sep 20.
The prognostic value of in-hospital haemoglobin drop in patients with acute coronary syndrome (ACS) undergoing invasive therapy remains insufficiently investigated.
This observational study included 3838 patients with ACS with admission and in-hospital nadir haemoglobin values available. Haemoglobin drop was defined as a positive difference between admission and nadir haemoglobin values. The primary endpoint was one-year all-cause mortality.
In-hospital haemoglobin drop occurred in 3142 patients (82%). Patients were categorized into 4 groups: no haemoglobin drop (n = 696 patients), <3 g/dl haemoglobin drop (n = 2703 patients), 3 to <5 g/dl haemoglobin drop (n = 344 patients) and ≥5 g/dl haemoglobin drop (n = 95 patients). The primary endpoint occurred in 156 patients: 17 patients (2.5%) in the group with no haemoglobin drop, 81 patients (3.0%) in the group with <3g/dl haemoglobin drop, 37 patients (10.9%) in the group with 3 to <5 g/dl haemoglobin drop and 21 patients (22.2%) in the group with ≥5 g/dl haemoglobin (adjusted hazard ratio [HR] = 1.30, 95% confidence interval 1.17 to 1.45; p < .001 for one g/dl haemoglobin drop). The association of haemoglobin drop with one-year mortality remained significant after exclusion of patients with in-hospital overt bleeding (adjusted HR = 1.27 [1.11-1.46]; p < .001 for one g/dl haemoglobin drop). The lowest haemoglobin drop associated with mortality was 1.23 g/dl in all patients (HR = 1.03 [1.02-1.04]) and 1.13 g/dl in patients without overt bleeding (HR = 1.03 [1.01-1.04]).
In patients with ACS, in-hospital haemoglobin drop was associated with higher risk of one-year mortality even in the absence of overt bleeding.
对于接受侵入性治疗的急性冠状动脉综合征（ACS）患者，住院期间血红蛋白下降的预后价值仍未得到充分研究。
这项观察性研究纳入了3838例有入院时及住院期间最低血红蛋白值的ACS患者。血红蛋白下降定义为入院时与最低血红蛋白值之间的正差值。主要终点为一年全因死亡率。
3142例患者（82%）出现住院期间血红蛋白下降。患者被分为4组：无血红蛋白下降（n = 696例患者）、血红蛋白下降<3 g/dl（n = 2703例患者）、血红蛋白下降3至<5 g/dl（n = 344例患者）以及血红蛋白下降≥5 g/dl（n = 95例患者）。156例患者出现主要终点：无血红蛋白下降组17例（2.5%）、血红蛋白下降<3 g/dl组81例（3.0%）、血红蛋白下降3至<5 g/dl组37例（10.9%）以及血红蛋白下降≥5 g/dl组21例（22.2%）（校正风险比[HR]=1.30，95%置信区间1.17至1.45；血红蛋白每下降1 g/dl，p<0.001）。排除住院期间有明显出血的患者后，血红蛋白下降与一年死亡率的关联仍然显著（校正HR = 1.27[1.11 - 1.46]；血红蛋白每下降1 g/dl，p<0.001）。所有患者中与死亡率相关的最低血红蛋白下降值为1.23 g/dl（HR = 1.03[1.02 - 1.04]），无明显出血的患者为1.13 g/dl（HR = 1.03[1.01 - 1.04]）。
在ACS患者中，即使没有明显出血，住院期间血红蛋白下降也与一年死亡率较高相关。
