Anemia of chronic disease (ACD) in the heart and respiratory failure: a comparative analysis
Anemia of chronic disease (ACD) takes the second place after the iron deficiency anemia. It masks the clinical presentations of main disease, worsens the prognosis and effectiveness of treatment, but its prevalence, impact and mechanisms have not been established yet. Aim: to study the frequency, clinical impact and role of inflammation in ACD in patients with chronic heart (CHF) and chronic respiratory (CRF) failures.
Methods: we did a literature review in Pubmed database and provided analise of medical records of 500 patients with coronary artery disease, stable stenocardia, CHF and 470 patients with chronic obstructive pulmonary disease, CRF. The results were statistically cheked using the Student’s criteria and Kaplan-Mayer method with Cox and Gehan-Wilcoxon criteria. Results were considered significant if p<0.05.
Results. Anemia is diagnosed equally frequently in heart or respiratory failure (32%), twice as common among men. The anemia was generally mild in both organs failures, but CRF was accompanied by an higher rate of moderate and severe forms. The normochromic normocytic character of ACD was predominated in both types of failures, but the patients with CRF had higher incidence of hyperchromia and less often microcytosis. ACD has multifactorial pathogenesis: inflammation, impaired iron metabolism, renal dysfunction, malabsorption, hemodilution, medications. Anemia affects the clinical manifestations of main pathology, its course and prognosis: it was an independent predictor of worse survival range in CRF and CHF during 36 months (58,9% against 82,3%, Cox F-test p=0,01; test Gehan-Wilcoxon p=0,053).
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