medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-14-134-140medsovet-6441Research ArticleКОМОРБИДНЫЙ ПАЦИЕНТCOMORBID PATIENTИндекс гетерогенности эритроцитов как биомаркер тяжести хронической сердечной недостаточности у пожилых пациентовRed blood cell distribution width as a biomarker of chronic heart failure severity in elderly patientshttps://orcid.org/0000-0002-2379-0450ГайсёнокО. В.GaisenokO. V.

Гайсёнок Олег Владимирович, к.м.н., заведующий отделением общей кардиологии

119285, Москва, Мичуринский проспект, д. 6

Scopus Author ID: 55943847600

Oleg V. Gaisenok, Cand. Sci. (Med.), Head of the General Cardiology Department

6, Michurinsky Prospect, Moscow, 119285

Scopus Author ID: 55943847600

ovgaisenok@fgu-obp.ruhttps://orcid.org/0000-0001-8228-1114ЛеоноваМ. В.LeonovaM. V.

Леонова Марина Васильевна, чл.‑корр. РАЕН, д.м.н., профессор, клинический фармаколог

400005, Волгоград, ул. Коммунистическая, д. 50

Scopus Author ID: 7004151126

Marina V. Leonova, Corr. Member RANS, Dr. Sci. (Med.), Professor, Clinical Pharmacologist

50, Kommunisticheskaya St., Volgograd, 400005

Scopus Author ID: 7004151126

anti23@mail.ruОбъединенная больница с поликлиникой Управления делами Президента РФРоссияUnited Hospital with Outpatient Department of the Presidential Administration of the Russian FederationRussian FederationМежрегиональная общественная организация «Ассоциация клинических фармакологов»РоссияInterregional Public Organization “Association of Clinical Pharmacologists”Russian Federation202117102021014134140Copyright © Гайсёнок О.В., Леонова М.В., 20212021Гайсёнок О.В., Леонова М.В.Gaisenok O.V., Leonova M.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6441

Введение. Хроническая сердечная недостаточность (ХСН) признана одним из наиболее тяжелых сердечно-сосудистых заболеваний с высоким уровнем смертности. Раннее выявление пациентов с риском неблагоприятного исхода имеет решающее значение для оптимизации лечения.Цель. Провести сравнительный анализ лабораторных маркеров, включая индекс гетерогенности эритроцитов (RDW), у пациентов с ХСН разных функциональных классов (ФК) по кодам МКБ-10.Материалы и методы. Проведено ретроспективное одномоментное исследование с анализом электронного лабораторного регистра (январь – декабрь 2016 г.). Включено 8056 пациентов, которым выполнен клинический анализ крови и добавлены показатели С-реактивного белка (СРБ). Определение принадлежности пациента к  ХСН выполнялось по  коду МКБ-10  при направлении на анализ. Идентификацию пациентов ХСН по ФК (NYHA) проводили по кодам МКБ-10: I25.2 (Перенесенный инфаркт миокарда) – 1-й ФК; I11.0 (Гипертензивная болезнь с преимущественным поражением сердца с сердечной недостаточностью) – 2–3-й ФК; I50.0 (Застойная сердечная недостаточность) – 4-й ФК.Результаты. Доля пациентов с болезнями системы кровообращения (код I) составила 33,4% (n = 2686), из них было отобрано 403  пациента с  ХСН для исследования. Распределение по  ФК по  коду МКБ-10  следующее: 1-й ФК  – 0,83% (n  =  67); 2–3-й ФК – 3,84% (n = 309); 4-й ФК – 0,33% (n = 27). Были получены достоверные межгрупповые различия между ФК (по критерию Краскела – Уоллиса) для показателей: гемоглобин (H = 9,741111, p = 0,0077), эритроциты (Н = 7,176770, р = 0,0276), индекс RDW (Н = 34,78287, р = 0,0000). Статистически достоверных различий для показателей лейкоцитов, тромбоцитов, СОЭ, СРБ обнаружено не было.Выводы. Не подтверждено наличие анемии в группах пациентов с ХСН разных ФК, которая часто сопровождает заболевание. Но при этом выявлены статистически значимые различия в зависимости от тяжести ФК ХСН по уровню гемоглобина, числу эритроцитов и высокодостоверные – по показателю RDW. Последнее позволяет обсуждать роль индекса RDW как возможно нового лабораторного биомаркера тяжести ХСН, доступного для рутинной клинической практики.

Introduction. Chronic heart failure (CHF) is recognized as one of the most severe cardiovascular diseases with a high mortality rate. Early identification of patients at risk of poor outcomes is critical to optimize treatment.Aim: to conduct comparative analysis of laboratory markers, including the erythrocyte heterogeneity index (RDW) in CHF patients of different functional classes (f.cl.) according to ICD-10 codes.Materials and methods. A  retrospective cross-sectional study with an analysis of  the  electronic laboratory register (JanuaryDecember 2016). 8056 patients who underwent a clinical blood test and added CRP parameters were included. The determination of the patient’s belonging to CHF wascarried out according to the ICD-10 code indicated in the direction for analysis. Identification of CHF patients by f.cl. (NYHA) was carried out according to the ICD-10 codes: code I25.2 (Postponed myocardial infarction) – 1 f. cl.; code I11.0 (Hypertensive disease with predominant heart damage with heart failure) – 2–3 f.cl .; code I50.0 (Congestive heart failure) – 4 f.cl.Results. The proportion of patients with diseases of the circulatory system (code I) was 33.4% (n = 2686), of which 403 CHF patients were selected for the study. Distribution by f.cl. according to the code MKB-10: 1 ph.cl. – 0.83% (n = 67); 2–3 f.c. – 3.84% (n = 309); 4 ph.cl. – 0.33% (n = 27). Significant intergroup differences were obtained between ph.cl. (according to Kruskal–Wallis) for  indicators: hemoglobin (H = 9.741111, p = 0.0077), erythrocytes (H = 7.176770, p = 0.0276), RDW indicator (H = 34.78287, p = 0.0000). There were no statistically significant differences in leukocytes, platelets, ESR, CRP.Conclusions. The presence of anemia in groups of patients with CHF of different f.cl., which often accompanies the disease, has not been confirmed. But statistically significant differences were revealed depending on the severity of f.cl. CHF according to the level of hemoglobin, the number of erythrocytes, and highly significant - according to the RDW indicator. The latter allows us to discuss the role of the RDW index as a possible new laboratory biomarker of CHF severity available for routine clinical practice.

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The authors declare that there are no conflicts of interest present.