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Krishnasivam D, Trentino KM, Burrows S, Farmer SL, Picardo S, Leahy MF, Halder A, Chamberlain J, Swain S, Muthucumarana K, Waterer G. Anemia in hospitalized patients: an overlooked risk in medical care. Transfusion 2018; 58:2522-2528. [PMID: 30276822 DOI: 10.1111/trf.14877] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in-hospital mortality and LOS. RESULTS Of 80,765 inpatients, 45,675 (56.55%) had anemia during admission. Mild and moderate/severe anemia were independently associated with increased in-hospital mortality (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.36-1.86, p = 0.001; OR 2.77, 95% CI 2.32-3.30, p < 0.001, respectively). Anemia was also associated with increased LOS, demonstrating a larger effect in emergency (mild anemia-incident rate ratio [IRR] 1.52, 95% CI 1.48-1.56, p < 0.001; moderate/severe anemia-IRR 2.18, 95% CI 2.11-2.26, p < 0.001) compared to elective admissions (mild anemia-IRR 1.30, 95% CI 1.21-1.41, p < 0.001; moderate/severe anemia-IRR 1.69, 95% CI 1.55-1.83, p < 0.001). LOS was longer in patients who developed anemia during admission compared to those who had anemia on admission (IRR 1.13, 95% CI 1.10-1.17, p < 0.001). Red cell transfusion was independently associated with 2.23 times higher odds of in-hospital mortality (95% CI 1.89-2.64, p < 0.001) and 1.31 times longer LOS (95% CI 1.25-1.37, p < 0.001). CONCLUSION More than one-third of patients not anemic on admission developed anemia during admission. Even mild anemia is independently associated with increased mortality and LOS; however, transfusion to treat anemia is an independent and additive risk factor.
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Affiliation(s)
| | - Kevin M Trentino
- Business Intelligence Unit, East Metropolitan Health Service, Perth, Australia.,Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | | | - Shannon L Farmer
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.,School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | - Michael F Leahy
- Department of Haematology, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Australia.,School of Medicine and Pharmacology, School of Laboratory Medicine, University of Western Australia, Perth, Australia
| | - Abir Halder
- Department of General Medicine, Perth, Australia
| | | | | | | | - Grant Waterer
- Faculty of Medicine, The University of Western Australia, Perth, Australia
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Anvardeen K, Yong G, Lam K, Larbalestier R, Krishnasivam D, Xu XF. O176 Cardiac remodelling post transcatheter aortic valve replacement – a single-centre Echocardiographic study. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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