红细胞分布宽度影响心力衰竭预后的Meta分析

A Meta-analysis of red cell distribution width in the prognosis of heart failure

目的:系统性分析红细胞分布宽度(red cell distribution width,RDW)对心力衰竭预后价值。方法:利用计算机检索pubmed,embase,web of science三大数据库研究心力衰竭和RDW的相关文献,检索时限为2018年12月5日。危害比(hazard ratio,HR)和95%置信区间(confidenceinterval,CI)作为统计指标。应用Stata12.0计算机软件进行分析,采用Q检验、随机效应模型进行meta分析。结果:共纳入13篇文献,13 311名患者,显示RDW升高,心力衰竭患者预后更差(HR=1.11,95%CI 1.08~1.13,I 2 =27%,P=0.172)。3篇有关于RDW的变化与急性心力衰竭预后,一共1 294名患者,合并HR=1.17,95%CI 1.08~1.26,I 2 =0,P=0.393。亚组分析结果提示:高水平RDW的急性心力衰竭患者死亡增高(HR=1.14,95%CI 1.10~1.17,P<0.01)。此外前瞻性研究(HR=1.10,95%CI 1.08~1.13),近5年发表文献(HR=1.11、95%CI 1.08~1.15)、多因素分析HR值(HR=1.10,95%CI 1.08~1.12)的差异具有统计学意义,异质性不显著。结论:入院时RDW对心力衰竭具有预后价值。

Objective: To evaluate the association between red cell distribution width (RDW) and clinical outcome of heart failure patients through a Meta-analysis. Methods: Relevant literatures were retrieved from pubmed, embase and web of science databases until December 5, 2018. Meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effect measures. Stata 12.0 software was used for analysis, and Q-test and random effect model were used for meta-analysis. Results: A total of 13 311 patients from 13 studies were finally enrolled in the meta-analysis. The summary results showed that elevated RDW predicted poorer mortality of heart failure patients (HR =1.11, 95%CI 1.08–1.13, I 2 =27%, P=0.172). There were 3 studies about changes in RDW and outcome of acute heart failure, 1 294 patients (HR =1.17, 95%CI 1.08–1.26, I 2 =0, P=0.393). Subgroup analysis showed that mortality increased in patients with acute heart failure with high RDW level (HR =1.14, 95%CI 1.10–1.17, P<0.01). In addition, rospective studies (HR =1.10, 95%CI 1.08–1.13), papers published in the past 5 years (HR =1.11, 95%CI 1.08–1.15), adjusted HR (HR =1.10, 95%CI 1.08–1.12), the difference is statistically significant, and heterogeneity is not significant. Conclusion: The elevated RDW on admission might be a predicative factor of poor prognosis for heart failure.