J Am Coll Cardiol:大多ACS住院患者存在无明显出血的血红蛋白降低,且与一年死亡率相关

2021-03-05 MedSci原创 MedSci原创

当代对出血终点的定义主要局限于临床显性事件。血红蛋白是否降低、是否伴有显性出血、是否会对急性冠脉综合征(ACS)患者的预后产生不利影响均尚不清楚。

当代对出血终点的定义主要局限于临床显性事件。血红蛋白是否降低、是否伴有显性出血、是否会对急性冠脉综合征(ACS)患者的预后产生不利影响均尚不清楚。

本研究的目的是在MATRIX试验中,评估院内血红蛋白降低在ACS患者中的发生率、预测因素和预后意义。

在基线和最低值的基础上,根据住院期间血红蛋白降低与否和降低幅度对患者进行分类,并进一步根据院内出血的发生情况进行分层。血红蛋白降低被定义为最小(<3g/dl)、轻微(3-5g/dl)或较多(≥5g/dl)。使用多变量Cox回归,对有和没有明显出血的患者的血红蛋白降低和死亡率之间的关系进行了建模。

住院患者的血红蛋白降低情况

在有血红蛋白数据的随机分组后存活24小时的7781例患者中,6504例(83.6%)患者存在血红蛋白降低,其中5756例(88.5%)无明显出血,748例(11.5%)有明显出血。

无明显出血的患者的血红蛋白降低情况及与一年死亡率的相关性

在无明显出血的患者中,轻微(HR 2.37;95%CI:1.32-4.24;P=0.004)和较多(2.58;0.98-6.78;P=0.054)血红蛋白降低与较高的1年死亡率独立相关。

有明显出血的患者的血红蛋白降低情况及与一年死亡率的相关性

在有明显出血的患者中,血红蛋白轻微和明显降低与1年死亡率的相关性倾向一致,但顺应性更广(次要 HR 3.53;95%CI 1.06-11.79];主要HR 13.32;3.01-58.98)。

综上,在接受侵袭性治疗的ACS患者中,即使在没有明显出血的情况下,住院期间血红蛋白降低≥3g/dl也很常见,并且与1年死亡率的增加独立相关。

原始出处:

Leonardi Sergio,Gragnano Felice,Carrara Greta et al. Prognostic Implications of Declining Hemoglobin Content in Patients Hospitalized With Acute Coronary Syndromes. J Am Coll Cardiol, 2021, 77: 375-388.

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    2021-08-24 waiwai3030
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    2021-03-07 yaanren
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    2021-03-06 WL

    写的很漂亮,我怎么不会

    0

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