Amplitud de distribución eritrocitaria y riesgo de mortalidad en pacientes con insuficiencia cardiaca aguda / Red cell distribution width and mortality risk in acute heart failure patients

Fundamento y objetivo: El ancho de distribución eritrocitaria (ADE) es una medida cuantitativa de la variabilidad del tamaño de los eritrocitos circulantes utilizada clásicamente para el diagnóstico diferencial de las anemias. En los últimos años, se ha sugerido que el ADE podría ser un marcador pronóstico útil en pacientes con insuficiencia cardiaca crónica. Sin embargo, es escasa la evidencia que respalda su papel en población no seleccionada con insuficiencia cardiaca aguda (ICA), de manera independiente a los factores de riesgo establecidos. El objetivo del estudio fue establecer la asociación entre el ADE y la mortalidad a largo plazo en pacientes ingresados por ICA. Pacientes y método: Se analizaron 1.190 pacientes consecutivos ingresados por ICA en nuestro centro. A todos los pacientes se les realizó una determinación de ADE durante el ingreso. Los valores del ADE se estratificaron en cuartiles (Q) y su asociación con la mortalidad total se evaluó mediante regresión de Cox. Resultados: Tras una mediana e seguimiento de 15 meses (intervalo intercuartílico 3-33 meses) se identificaron 458 (38%) muertes. Se observó un incremento progresivo de las tasas de mortalidad desde Q1 a Q4: 1,34, 1,82, 2,56 y 3,53 por 10 pacientes-año de seguimiento para Q1, Q2, Q3 y Q4, respectivamente (p de la tendencia<0,001). En el análisis multivariante, esta asociación se mantuvo independiente para los pacientes pertenecientes a Q3 (15-16%) y Q4 (>16%) frente a Q1 (≤14%): hazard ratio [HR] 1,66, intervalo de confianza del 95% [IC 95%] 1,24-2,22, p<0,01; y HR 1,80, IC 95% 1,33-2,43, p<0,01, respectivamente, en un modelo ajustado por las variables pronósticas establecidas en ICA. Conclusión: En pacientes con ICA los valores elevados del ADE se asocian a una mayor mortalidad a largo plazo (AU)

Background and objective: Red cell distribution width (RDW) is a quantitative measure of the variability in size of erythrocytes, and it is used for the differential diagnosis of anemia. Recent reports have suggested that high RDW could play a role for risk stratification in patients with chronic heart failure. However, the prognostic role of RDW in unselected population with acute heart failure (AHF), after a thoroughly multivariate adjustment, has not been well established. The aim of this study was to establish the association between RDW and long-term mortality in patients admitted for AHF. Patients and method: We analyzed 1,190 consecutive patients admitted for AHF in our center. RDW measurement was performed on admission. RDW values were stratified into quartiles (Q) and the association of RDW with total mortality was assessed using Cox regression. Results: After a median follow-up of 15 months (interquartile range 3-33 months) 458 (38%) deaths were identified. There was a progressive increase in mortal y rates from Q1 to Q4: 1.34, 1.82, 2.56 and 3.53 per 10 patients-year of follow-up (for Q1, Q2, Q3 and Q4 respectively, P for trend <.001). In the multivariate analysis, this association remained independent for patients in Q3 (15-16%) and Q4 (>16%) versus Q1 (≤14%), hazard ratio (HR): 1.66, 95% confidence interval (95% CI) 1.24-2.22, P<.01, HR: 1.80, 95% CI 1.33-2.43, p<.01, respectively, in a model adjusted for established prognostic markers in AHF. Conclusion: In patients with AHF, higher RDW values were associated with increased long-term mortality (AU)

[Red cell distribution width and mortality risk in acute heart failure patients]. / Amplitud de distribución eritrocitaria y riesgo de mortalidad en pacientes con insuficiencia cardiaca aguda.

BACKGROUND AND OBJECTIVE: Red cell distribution width (RDW) is a quantitative measure of the variability in size of erythrocytes, and it is used for the differential diagnosis of anemia. Recent reports have suggested that high RDW could play a role for risk stratification in patients with chronic heart failure. However, the prognostic role of RDW in unselected population with acute heart failure (AHF), after a thoroughly multivariate adjustment, has not been well established. The aim of this study was to establish the association between RDW and long-term mortality in patients admitted for AHF. PATIENTS AND METHOD: We analyzed 1,190 consecutive patients admitted for AHF in our center. RDW measurement was performed on admission. RDW values were stratified into quartiles (Q) and the association of RDW with total mortality was assessed using Cox regression. RESULTS: After a median follow-up of 15 months (interquartile range 3-33 months) 458 (38%) deaths were identified. There was a progressive increase in mortality rates from Q1 to Q4: 1.34, 1.82, 2.56 and 3.53 per 10 patients-year of follow-up (for Q1, Q2, Q3 and Q4 respectively, P for trend <.001). In the multivariate analysis, this association remained independent for patients in Q3 (15-16%) and Q4 (>16%) versus Q1 (≤14%), hazard ratio (HR): 1.66, 95% confidence interval (95% CI) 1.24-2.22, P<.01, HR: 1.80, 95% CI 1.33-2.43, p<.01, respectively, in a model adjusted for established prognostic markers in AHF. CONCLUSION: In patients with AHF, higher RDW values were associated with increased long-term mortality.

Mediciones seriadas de antígeno carbohidrato 125 tras un ingreso por insuficiencia cardiaca aguda y riesgo de reingreso precoz / Carbohydrate Antigen 125 Serial Measurements after an Admission for Acute Heart Failure and Risk of Early Readmission

Fundament and objectives: The early readmission after a hospitalization for acute heart failure (AHF) is frequent; however, factors associated are not clearly established. Plasma levels of carbohydrate antigen 125 (CA125) have shown to be associated with the presence of systemic congestion and increased risk of death in patients with AHF. The aim of this study was to assess the relationship between CA125 levels (during hospitalization, at the first outpatient visit or their changes) and readmission for AHF at 6 months follow up. Patients and method: We analyzed 293 consecutive patients hospitalized for AHF in which CA125 was determined during the index hospitalization (T1) and the first outpatient visit after discharge (T2) (median 31 days). We examined the relationship between CA125 levels, both isolated determinations as their serial changes (absolute, relative or categorical) and readmission for AHF by Cox regression analysis adjusted for competing events. The reclassification technique integrated discrimination improvement (IDI) index was used to assess the additional discriminative power of this biomarker over the final multivariate model. Results: At 6 months follow up, we identified 32 (10.9%) and 54 (18.4%) deaths and readmissions for AHF, respectively. CA125 categorical changes [decrease and normalization (C1, n=153), decrease but no normalization at T2 (C2, n=72) and increase, with high levels at T2 (>35 U/ml) (C3, n=68)], followed by the isolated determination of CA125 at T2, showed the best discriminative accuracy. Thus, with respect to patients in the C1 category, patients in categories C2 and C3 showed a higher risk of readmission for AHF: C2 vs. C1: HR=3.48, 95% CI:1.84-6.59, p<0.001; C3 vs. C1: HR=3.18, 95% CI:1.62-6.21, p=0.001 (AU)

Fundamento y objetivos: El reingreso precoz tras una hospitalización por insuficiencia cardiaca aguda (ICA) es frecuente, sin embargo, los factores asociados a este no están claramente establecidos. Los valores plasmáticos del antígeno carbohidrato 125 (CA125) han mostrado asociarse con la presencia de congestión sistémica y aumento del riesgo de muerte en pacientes con ICA. El objetivo de este trabajo fue determinar la relación entre los valores de CA125 (durante el ingreso, en la primera visita ambulatoria o sus cambios) y el reingreso por ICA a 6 meses de seguimiento. Pacientes y método: Analizamos 293 pacientes consecutivos ingresados por ICA en los que se determinó el CA125 durante la hospitalización índice (T1) y en la primera visita ambulatoria (T2) tras el alta (mediana 31 días). Evaluamos la relación entre el CA125, tanto sus determinaciones aisladas como sus cambios seriados (absolutos, relativos o categóricos), y el reingreso precoz por ICA mediante análisis de regresión de Cox adaptado para episodios competitivos. La técnica de reclasificación «integrated discrimination improvement index» se utilizó para evaluar la capacidad discriminativa adicional de este biomarcador sobre el modelo multivariante final. Resultados: A 6 meses de seguimiento, se identificaron 32 (10,9%) y 54 (18,4%) muertes y reingresos por ICA, respectivamente. Los cambios categóricos de CA125 (descenso y normalización en T2 [C1, n=153], descenso pero no normalización en T2 [C2, n=72] e incremento con valores elevados en T2 [>35U/ml] [C3, n=68]), seguidos de su determinación aislada en T2, mostraron la mejor capacidad discriminativa sobre el modelo basal (AU)

[Carbohydrate antigen 125 serial measurements after an admission for acute heart failure and risk of early readmission]. / Mediciones seriadas de antígeno carbohidrato 125 tras un ingreso por insuficiencia cardiaca aguda y riesgo de reingreso precoz.

UNLABELLED: FUNDAMENT AND OBJECTIVES: The early readmission after a hospitalization for acute heart failure (AHF) is frequent; however, factors associated are not clearly established. Plasma levels of carbohydrate antigen 125 (CA125) have shown to be associated with the presence of systemic congestion and increased risk of death in patients with AHF. The aim of this study was to assess the relationship between CA125 levels (during hospitalization, at the first outpatient visit or their changes) and readmission for AHF at 6 months follow up. PATIENTS AND METHOD: We analyzed 293 consecutive patients hospitalized for AHF in which CA125 was determined during the index hospitalization (T1) and the first outpatient visit after discharge (T2) (median 31 days). We examined the relationship between CA125 levels, both isolated determinations as their serial changes (absolute, relative or categorical) and readmission for AHF by Cox regression analysis adjusted for competing events. The reclassification technique integrated discrimination improvement (IDI) index was used to assess the additional discriminative power of this biomarker over the final multivariate model. RESULTS: At 6 months follow up, we identified 32 (10.9%) and 54 (18.4%) deaths and readmissions for AHF, respectively. CA125 categorical changes [decrease and normalization (C1, n=153), decrease but no normalization at T2 (C2, n=72) and increase, with high levels at T2 (>35 U/ml) (C3, n=68)], followed by the isolated determination of CA125 at T2, showed the best discriminative accuracy. Thus, with respect to patients in the C1 category, patients in categories C2 and C3 showed a higher risk of readmission for AHF: C2 vs. C1: HR=3.48, 95% CI:1.84-6.59, p<0.001; C3 vs. C1: HR=3.18, 95% CI:1.62-6.21, p=0.001. On the other hand, patients with elevated levels of CA125 in T2 (>35 U/ml) (41%) tripled the risk of readmission for AHF at 6 months compared with those with normal levels of CA125 at T2: HR=3.06, 95% CI:1.79-5.23, p<0.001. The addition of the categories of serial measurements of CA125 and the presence of elevated levels of CA125 at T2 showed a significant increase in the discriminating power of 6.27% and 6.17% in the IDI index, respectively. CONCLUSIONS: After an episode of AHF, the elevation of CA125 levels (>35 U/ml) after the first weeks of admission is associated with an increased risk of readmission for AHF.