title: Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome.
abstract: In this work, we analyzed the prognostic significance of changes in hemoglobin during intensive care unit (ICU) stay in patients with acute coronary syndromes (ACS). We prospectively enrolled 591 patients (62 ± 14 years old, 73% male, 48% ST elevated myocardial infarction) free of blood cell transfusion or bleeding events. Changes in hemoglobin between admission and ICU discharge were obtained. The primary endpoint was death or hospitalization for MI within 6 months. Hemoglobin decreased from 13.65 ± 1.77 to 13.17 ± 1.74 g/dl, p < 0.0001 in the whole population. The end point was reached in 43 patients at a mean follow-up of 180 (range 2-180 days). A decrease in hemoglobin ≥0.9 g/dl (32% of the population) was associated with adverse clinical outcomes (HR 2.37, 95% CI (1.30-4.35), p = 0.005, respectively). In multivariate analysis, age >77 year-old (p = 0.0016), Killip class ≥2 (p = 0.009), anemia (p = 0.0064), decreased estimated glomerular filtration rate (p = 0.003), and hemoglobin decline ≥0.9 g/dl (p < 0.0001) were independently associated with outcome. Hemoglobin decline and anemia both provided additional prognostic information on top of the GRACE score, as demonstrated by a systematic improvement in model global fit, discrimination, and calibration. Hemoglobin decline is frequent during ICU stay in non-bleeding ACS patients. A decline in hemoglobin ≥0.9 g/dl identifies high-risk patients. Identification of these patients refines the prognostic value of the GRACE score.
authors.affiliation: Cardiology Department, Groupement Hospitalier Saint Philibert, Faculté Libre de Médecine de Lille, rue du Grand But, Lomme, 59160 Lille Cedex, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Barrailler
authors.forename: Claire
authors.initials: C
authors.lastname: Pinçon
authors.forename: Vincent
authors.initials: V
authors.lastname: Decourcelle
authors.forename: Thomas
authors.initials: T
authors.lastname: Guidez
authors.forename: Sophie
authors.initials: S
authors.lastname: Braun
authors.forename: Nadia
authors.initials: N
authors.lastname: Bouabdallaoui
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Bauchart
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Auffray
authors.forename: Francis
authors.initials: F
authors.lastname: Juthier
authors.forename: Carlo
authors.initials: C
authors.lastname: Banfi
authors.forename: Sophie
authors.initials: S
authors.lastname: Susen
authors.forename: Brigitte
authors.initials: B
authors.lastname: Jude
authors.forename: Philippe
authors.initials: P
authors.lastname: Asseman
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.forename: Pierre Vladimir
authors.initials: PV
authors.lastname: Ennezat
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D000368:Aged; D000740:Anemia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D015536:Down-Regulation; D005260:Female; D005602:France; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins