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Anaemia is a predictor of early death or cardiac transplantation in children with idiopathic dilated cardiomyopathy

Published online by Cambridge University Press:  13 October 2011

Issam Kammache ,
Giovanni Parrinello ,
Davide Marini ,
Damien Bonnet  and
Gabriella Agnoletti
Issam Kammache
Affiliation:
Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Giovanni Parrinello
Affiliation:
Section of Medical Statistics, Department of Biomedical Science, University of Brescia, Brescia, Italy
Davide Marini
Affiliation:
Department of Paediatric Cardiology, Paediatric Hospital Regina Margherita, Turin, Italy
Damien Bonnet
Affiliation:
Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Gabriella Agnoletti*
Affiliation:
Department of Paediatric Cardiology, Paediatric Hospital Regina Margherita, Turin, Italy
*
Correspondence to: Dr G. Agnoletti, Department of Paediatric Cardiology, Ospedale Infantile Regina Margherita, Piazza Polonia, 10124 Torino, Italy. Tel: 0033 1 44494356; Fax: 0033 1 44495724; E-mail: gabriella.agnoletti@oirmsantanna.piemonte.it
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Abstract

Introduction

The aim of our study was to establish the prevalence and the prognostic value of haematological abnormalities in children with cardiac failure.

Patients and methods

A series of 218 consecutive children with a first diagnosis of idiopathic dilated cardiomyopathy were retrospectively examined. Haematological evaluation was performed at first diagnosis. Death or cardiac transplantation was the main outcome measure.

Results

The median age was 0.6 years, ranging from 1 day to 15.8 years and median follow-up was 2.65 years, ranging from 0 to 17.2 years. After a median interval of 0.2 years, ranging from 0 to 8.7 years, 56 patients died and 25 were transplanted. Event-free survival at 1 and 5 years was 68% (95% confidence interval, 63–75%) and 62% (95% confidence interval, 56–69%). Blood levels of haemoglobin less than 10 grams per decilitre, urea over 8 millimoles per litre, and C-reactive protein over 10 milligrams per litre were found in 24%, 20%, and 24% of patients, respectively. The log-rank test showed that haemoglobin (p = 0.000) and C-reactive protein (p = 0.021) were predictors of death or transplantation. In the multivariate Cox model, haemoglobin (hazard ratio = 0.735; confidence interval = 0.636–0.849; p = 0.000) and urea (hazard ratio = 1.083; confidence interval = 1:002–1:171; p = 0.045) were predictive of poor outcome. Cubic spline functions showed that the positive role of haemoglobin on survival was linear for values less than 12 grams per decilitre and null for values more than 12 grams per decilitre. Adaptive index models for risk stratification and Classification and Regression Tree analysis allowed to identify the cut-off values for haemoglobin (less than 10.2 grams per decilitre) and urea (more than 8.8 millimoles per litre), as well as to derive a predictor model.

Conclusions

In children with idiopathic dilated cardiomyopathy, anaemia is the strongest independent prognostic factor of early death or transplantation.

Keywords

Haemoglobincardiac failuremyocardiopathy
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 3 , June 2012 , pp. 293 - 300
Copyright
Copyright © Cambridge University Press 2012

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