Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego · 2016
[The usefulness of complete blood count in predicting cardiac rehabilitation failure in post-NSTEMI patients].
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Obrębska-Stefaniak Agnieszka, Irzmański Robert, Grycewicz Tomasz, Kapusta Joanna, Kowalski Jan
Аннотация
UNLABELLED: ACS (acute coronary syndrome) NSTEMI is more prevalent than ACS STEMI. Within four years the mortality rate was twice higher in NSTEMI group than in the STEMI group. Studies have demonstrated that cardiac rehabilitation decreases the risk of all-cause mortality as well as the mortality related to cardiovascular events.
AIM: The aim of the study was to evaluate with the use of an index of own design the prognostic value of the complete blood count (CBC) in predicting cardiac rehabilitation failure in post-NSTEMI patients.
MATERIALS AND METHODS: The study comprised 116 post-NSTEMI patients, 81 men and 35 women, aged 64,12±11,29 years, admitted for cardiac rehabilitation to the Department of Internal Medicine and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/1.73m2, RBC < 4x106 μl, WBC > 10x103/μl, PLT < 150x103/μl. Exercise test (cycloergometer) was performed twice in all patients - before and after the completion (4 weeks) of the II phase of the rehabilitation to assess its effects.
RESULTS: Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Anemia and leucocytosis determined most significantly the failure of cardiac rehabilitation (respectively OR=2,77 and OR=2,36; p=0,01). They were used to construct a rehabilitation failure index with the values ranging from 0 to 2, where 0 - corresponds to absence of anemia and leucocytosis, 1 - corresponds to the occurrence of anemia or leucocytosis in post-NSTEMI patients and was associated with 2,65-fold increase of the risk of cardiac rehabilitation failure, 2 - corresponds to simultaneous occurrence of anemia and leucocytosis and was associated with 7,02-fold increase of the risk of cardiac rehabilitation failure.
CONCLUSIONS: Complete blood count is useful in predicting cardiac rehabilitation failure. Anemia and leucocytosis are the most significant determinants of cardiac rehabilitation failure in post-NSTEMI patients. Cardiac rehabilitation failure index can be used for its individual programming. Then optimal rehabilitation effects can be obtained maintaining its safety in post-NSTEMI patients.
AIM: The aim of the study was to evaluate with the use of an index of own design the prognostic value of the complete blood count (CBC) in predicting cardiac rehabilitation failure in post-NSTEMI patients.
MATERIALS AND METHODS: The study comprised 116 post-NSTEMI patients, 81 men and 35 women, aged 64,12±11,29 years, admitted for cardiac rehabilitation to the Department of Internal Medicine and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/1.73m2, RBC < 4x106 μl, WBC > 10x103/μl, PLT < 150x103/μl. Exercise test (cycloergometer) was performed twice in all patients - before and after the completion (4 weeks) of the II phase of the rehabilitation to assess its effects.
RESULTS: Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Anemia and leucocytosis determined most significantly the failure of cardiac rehabilitation (respectively OR=2,77 and OR=2,36; p=0,01). They were used to construct a rehabilitation failure index with the values ranging from 0 to 2, where 0 - corresponds to absence of anemia and leucocytosis, 1 - corresponds to the occurrence of anemia or leucocytosis in post-NSTEMI patients and was associated with 2,65-fold increase of the risk of cardiac rehabilitation failure, 2 - corresponds to simultaneous occurrence of anemia and leucocytosis and was associated with 7,02-fold increase of the risk of cardiac rehabilitation failure.
CONCLUSIONS: Complete blood count is useful in predicting cardiac rehabilitation failure. Anemia and leucocytosis are the most significant determinants of cardiac rehabilitation failure in post-NSTEMI patients. Cardiac rehabilitation failure index can be used for its individual programming. Then optimal rehabilitation effects can be obtained maintaining its safety in post-NSTEMI patients.