Ikeda Shinya, Yamashita Yugo, Morimoto Takeshi, Chatani Ryuki, Kaneda Kazuhisa, Nishimoto Yuji, Ikeda Nobutaka, Kobayashi Yohei, Ikeda Satoshi, Kim Kitae, Inoko Moriaki, Takase Toru, Tsuji Shuhei, Oi Maki, Takada Takuma, Otsui Kazunori, Sakamoto Jiro, Ogihara Yoshito, Inoue Takeshi, Usami Shunsuke, Chen Po-Min, Togi Kiyonori, Koitabashi Norimichi, Hiramori Seiichi, Doi Kosuke, Mabuchi Hiroshi, Tsuyuki Yoshiaki, Murata Koichiro, Takabayashi Kensuke, Nakai Hisato, Sueta Daisuke, Shioyama Wataru, Dohke Tomohiro, Nishikawa Ryusuke, Ono Koh, Kimura Takeshi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Department of Pharmacology, Shiga University of Medical Science.
Circ J. 2025 Apr 25;89(5):592-601. doi: 10.1253/circj.CJ-24-0581. Epub 2024 Oct 22.
White blood cell (WBC) counts were reported to be a risk factor for acute adverse events in patients with venous thromboembolism (VTE). However, there are limited data on VTE patients without active cancer.
The COMMAND VTE Registry-2 was a multicenter study enrolling 5,197 consecutive patients with acute symptomatic VTE. We divided 3,668 patients without active cancer into 4 groups based on WBC count quartiles (Q1-Q4) at diagnosis: Q1, ≤5,899 cells/μL; Q2, 5,900-7,599 cells/μL, Q3, 7,600-9,829 cells/μL; and Q4, ≥9,830 cells/μL. Patients in Q4 more often presented with pulmonary embolism (PE) than patients in Q1, Q2, and Q3 (68% vs. 37%, 53%, and 61%, respectively; P<0.001). The proportion of massive PEs among all PEs was higher in Q4 than in Q1, Q2, and Q3 (21% vs. 3.4%, 5.8%, and 11%, respectively; P<0.001). Compared with Q1, Q2, and Q3, patients in Q4 had a higher cumulative 5-year incidence of all-cause death (17.0%, 15.2%, 16.1%, and 22.8%, respectively; P<0.001) and major bleeding (10.9%, 11.0%, 10.3%, and 14.4%, respectively; P=0.002). The higher mortality risk of Q4 relative to Q2 was consistent regardless of the presentations of VTEs.
An elevated WBC count on VTE diagnosis was associated with a higher risk of mortality and major bleeding regardless of VTE presentation, suggesting the potential usefulness of WBC counts for further risk stratification.
据报道，白细胞（WBC）计数是静脉血栓栓塞症（VTE）患者发生急性不良事件的一个危险因素。然而，关于无活动性癌症的VTE患者的数据有限。
COMMAND VTE注册研究-2是一项多中心研究，连续纳入了5197例急性症状性VTE患者。我们将3668例无活动性癌症的患者根据诊断时的白细胞计数四分位数（Q1-Q4）分为4组：Q1，≤5899个细胞/μL；Q2，5900-7599个细胞/μL；Q3，7600-9829个细胞/μL；Q4，≥9830个细胞/μL。与Q1、Q2和Q3组的患者相比，Q4组患者更常出现肺栓塞（PE）（分别为68%对37%、53%和61%；P<0.001）。Q4组所有PE中大面积PE的比例高于Q1、Q2和Q3组（分别为21%对3.4%、5.8%和11%；P<0.001）。与Q1、Q2和Q3组相比，Q4组患者全因死亡的累积5年发生率更高（分别为17.0%、15.2%、16.1%和22.8%；P<0.001），大出血发生率也更高（分别为10.9%、11.0%、10.3%和14.4%；P=0.002）。无论VTE的表现如何，Q4组相对于Q2组较高的死亡风险都是一致的。
VTE诊断时白细胞计数升高与更高的死亡风险和大出血风险相关，无论VTE的表现如何，这表明白细胞计数对于进一步的风险分层可能有用。
