Wen Song, Zhou Shuheng, Wang Wei, Qiu Xueting, Feng Yingqing
Department of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University Guangzhou Guangdong China.
Department of Cardiac Surgery Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University Guangzhou Guangdong China.
J Am Heart Assoc. 2025 Sep 16;14(18):e041978. doi: 10.1161/JAHA.125.041978. Epub 2025 Sep 4.
Cardio-renal-metabolic multimorbidity is common and a major cause of death. This study investigates the associations between hematologic parameters and all-cause death, aiming to redefine complete blood count reference intervals for individuals with cardio-renal-metabolic multimorbidity.
The study cohort consisted of 4482 adults drawn from the National Health and Nutrition Examination Survey conducted between 1999 and 2018. To assess the associations of hemoglobin concentration, platelet count, white blood cell count, and systemic inflammatory response index with the risk of all-cause death, multivariable Cox regression and restricted cubic spline regression analyses were used. Subgroup and sensitivity analyses were performed to ensure the robustness of the findings.
Over a median follow-up of 71 (36-121) months, 2025 deaths (42%) occurred. After adjusting for potential confounding variables, participants with hemoglobin of ≥13.7 g/dL, platelet count of 228-356×10cells/μL, and white blood cell count of ≤10.1×10cells/μL exhibited a 28% (hazard ratio [HR], 0.72 [95% CI, 0.63-0.81]; <0.001), 15% (HR, 0.85 [95% CI, 0.74-0.98]; =0.023), and 19% (HR, 0.81 [95% CI, 0.69-0.96]; =0.013) reduction in the risk of all-cause death, respectively. Conversely, participants in the highest systemic inflammatory response index tertile experienced a 52% increased risk of all-cause death compared with those in the lowest tertile (HR, 1.52 [95% CI, 1.29-1.78]; <0.001).
Alterations in hematologic parameters are significantly correlated with all-cause death in patients with cardio-renal-metabolic multimorbidity. Keeping these parameters within optimal ranges greatly reduces the mortality rate, highlighting the importance for clinicians managing patients with cardio-renal-metabolic multimorbidity to closely monitor hematologic changes and implement appropriate interventions.
心肾代谢共病很常见，是主要的死亡原因。本研究调查血液学参数与全因死亡之间的关联，旨在重新定义心肾代谢共病个体的全血细胞计数参考区间。
研究队列由1999年至2018年期间进行的美国国家健康与营养检查调查中的4482名成年人组成。为评估血红蛋白浓度、血小板计数、白细胞计数和全身炎症反应指数与全因死亡风险的关联，采用多变量Cox回归和限制性立方样条回归分析。进行亚组分析和敏感性分析以确保研究结果的稳健性。
在中位随访71（36 - 121）个月期间，发生了2025例死亡（42%）。在调整潜在混杂变量后，血红蛋白≥13.7 g/dL、血小板计数为228 - 356×10⁹细胞/μL、白细胞计数≤10.1×10⁹细胞/μL的参与者全因死亡风险分别降低了28%（风险比[HR]，0.72[95%置信区间，0.63 - 0.81]；P < 0.001）、15%（HR，0.85[95%置信区间，0.74 - 0.98]；P = 0.023）和19%（HR，0.81[95%置信区间，0.69 - 0.96]；P = 0.013）。相反，全身炎症反应指数最高三分位数的参与者与最低三分位数的参与者相比，全因死亡风险增加了52%（HR，1.52[95%置信区间，1.29 - 1.78]；P < 0.001）。
血液学参数的改变与心肾代谢共病患者的全因死亡显著相关。将这些参数保持在最佳范围内可大大降低死亡率，突出了临床医生管理心肾代谢共病患者时密切监测血液学变化并实施适当干预的重要性。
