Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego · 2016
[The prognostic value of basic laboratory blood tests in predicting the results of cardiac rehabilitation in post STEMI patients].
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Obrębska Agnieszka, Irzmański Robert, Grycewicz Tomasz, Mejer Anna, Kowalski Jan
Аннотация
UNLABELLED: The possibility of complications and death from cardiovascular causes in patients with acute coronary syndromes (ACS) is an important element in the assessment of their clinical condition. It is believed that the prognosis of patients after ACS is affected, among others, by leukocytosis, anemia, hyperglycemia, thrombocytopenia, and increased volume of these cells and decreased GFR.
AIM: The aim of the study was an attempt to use basic laboratory blood tests and an index of own design to predict the results of in-hospital cardiac rehabilitation (phase II) of post STEMI patients.
MATERIALS AND METHODS: The study included 100 post STEMI patients, 70 men and 30 women, aged 60,9±11,8 years, admitted for cardiac rehabilitation to the Department of Internal Diseases 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 ≥100mg/dl, GFR <60 ml/min/1,73m(2), RBC <4x10(6)/μl, WBC >10x10(3)/μl, PLT <150x10(3)/μl. Exercise test was performed twice in all patients - before and after the completion of the II phase of 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 workload increment ≥20 Watt 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. Leukocytosis and anemia determined most significantly the failure of cardiac rehabilitation (respectively: OR=6,4 and OR=2,9;p=0,01). They were used to construct a rehabilitation failure index with the values 0-2, as follows: 0 - corresponds to the situation of the absence of leukocytosis and anemia, 1 - corresponds to the situation of the occurrence of leucocytosis or anemia in post STEMI patients and was associated with 3,5-fold increase in the risk of not obtaining the full effect of cardiac rehabilitation, 2 - corresponds to the situation of the simultaneous occurrence of both parameters (leukocytosis and anemia) and was associated with 12,25-fold increase in the risk of not obtaining full effect of cardiac rehabilitation.
CONCLUSIONS: Peripheral blood cell count is essential in predicting cardiac rehabilitation effects. Leukocytosis and anemia determine to the greatest degree the failure of cardiac rehabilitation. Cardiac rehabilitation failure index may be useful in classifying post STEMI patients into an appropriate model of rehabilitation.
AIM: The aim of the study was an attempt to use basic laboratory blood tests and an index of own design to predict the results of in-hospital cardiac rehabilitation (phase II) of post STEMI patients.
MATERIALS AND METHODS: The study included 100 post STEMI patients, 70 men and 30 women, aged 60,9±11,8 years, admitted for cardiac rehabilitation to the Department of Internal Diseases 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 ≥100mg/dl, GFR <60 ml/min/1,73m(2), RBC <4x10(6)/μl, WBC >10x10(3)/μl, PLT <150x10(3)/μl. Exercise test was performed twice in all patients - before and after the completion of the II phase of 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 workload increment ≥20 Watt 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. Leukocytosis and anemia determined most significantly the failure of cardiac rehabilitation (respectively: OR=6,4 and OR=2,9;p=0,01). They were used to construct a rehabilitation failure index with the values 0-2, as follows: 0 - corresponds to the situation of the absence of leukocytosis and anemia, 1 - corresponds to the situation of the occurrence of leucocytosis or anemia in post STEMI patients and was associated with 3,5-fold increase in the risk of not obtaining the full effect of cardiac rehabilitation, 2 - corresponds to the situation of the simultaneous occurrence of both parameters (leukocytosis and anemia) and was associated with 12,25-fold increase in the risk of not obtaining full effect of cardiac rehabilitation.
CONCLUSIONS: Peripheral blood cell count is essential in predicting cardiac rehabilitation effects. Leukocytosis and anemia determine to the greatest degree the failure of cardiac rehabilitation. Cardiac rehabilitation failure index may be useful in classifying post STEMI patients into an appropriate model of rehabilitation.