Prevalence of and Recovery From Anemia Following Hospitalization for Critical Illness Among Adults.
Prevalence of and Recovery From Anemia Following Hospitalization for Critical Illness Among Adults.
复制标题
DOI：
10.1001/jamanetworkopen.2020.17843
复制
发表时间：
2020-09-01
影响因子：
13.8
通讯作者：
Kor DJ
中科院分区：
文献类型：
--
作者：
Warner MA;Hanson AC;Frank RD;Schulte PJ;Go RS;Storlie CB;Kor DJ
危重症患者贫血与出院后持续贫血是否相关？在这项对 6901 名因危重病住院的成年人进行的队列研究中，41% 的人在住院前患有普遍贫血，而在院前没有贫血的人中，74% 的人发生了意外贫血，出院时总体贫血患病率为 80%。对于那些进行血红蛋白评估的存活者，出院后 12 个月从出院贫血完全恢复的比例为：轻度贫血为 58%，中度贫血为 39%，重度贫血为 24%。这项研究的结果表明，贫血很常见，并且在危重疾病后的第一年往往持续存在。贫血很常见，并且与危重患者的不良预后相关，但血红蛋白恢复的时间和程度仍未完全描述，这可能对重症监护出院后的临床结果产生重要影响。描述危重病期间和之后贫血状态的纵向变化，并评估血红蛋白浓度与出院后死亡率之间的关联。一项基于人群的队列研究于2010年1月1日至2016年12月31日在明尼苏达州奥姆斯特德县进行；数据分析于2019年6月1日至12月30日进行。参与者包括6901名入住重症监护室的成年人（年龄≥18岁）。住院前 12 个月、住院期间和出院后 12 个月的血红蛋白浓度，按贫血严重程度分类（轻度，女性血红蛋白 ≥10.0 至 <12.0 g/dL，男性 ≥10.0 至 <13.5 g/dL；中度，血红蛋白 ≥8.0 至 <10.0 g/dL；重度，血红蛋白 <8.0克/分升）。贫血完全恢复（定义为住院后 12 个月达到非贫血状态）和 12 个月死亡率也进行了评估。在该研究纳入的 6901 名患者中，3792 名是男性（55%）；中位年龄（四分位距 [IQR]）为 67（IQR，52-79）岁。 83% 的人群 (n = 5694) 可获得院前血红蛋白浓度，中位血红蛋白浓度为 13.1 (IQR，11.6-14.4) g/dL。百分之四十一的患者 (n=2320) 在住院前患有贫血。出院时的血红蛋白值为 10.8 g/dL（IQR，9.5-12.4 g/dL），其中 80%（n = 6460 人中的 5182 人）患有贫血：58% 为轻度，39% 为中度，3% 为重度。在有可用血红蛋白测量值的存活者中，住院后 3 个月时贫血患病率为 56%（95% CI，55%-58%），6 个月时为 52%（95% CI，50%-54%），12 个月时为 45%（95% CI，43%-47%）。 12个月时，轻度贫血完全恢复率为58%（95% CI，56%-61%），中度贫血为39%（95% CI，36%-42%），重度贫血为24%（95% CI，15%-34%）。在住院后没有基线贫血的患者中，74%的患者出院时贫血，轻度贫血12个月完全恢复率为73%（95% CI，69%-76%），中度贫血为62%（95% CI，57%-68%），重度贫血为59%（95% CI，35%-82%）。多变量调整后，较高的出院血红蛋白浓度与死亡率降低相关（风险比，每增加 1 g/dL 0.95；95% CI，0.90-0.99，P = .02）。这项研究的结果表明，贫血很常见，并且在危重疾病后的第一年往往持续存在。需要进一步的研究来确定不同的贫血恢复情况并评估与临床结果的关联。该队列研究检查了危重患者贫血的存在情况以及出院后的结果。
Is anemia in patients with critical illness associated with persistent anemia following discharge? In this cohort study of 6901 adults hospitalized for critical illness, 41% had prevalent anemia preceding hospitalization and 74% of those without prehospitalization anemia developed incident anemia, for an overall anemia prevalence of 80% at hospital discharge. Rates of complete recovery from hospital discharge anemia at 12 months posthospitalization for those alive with available hemoglobin assessments were 58% for mild anemia, 39% for moderate anemia, and 24% for severe anemia. The findings of this study suggest that anemia is common and often persistent in the first year after critical illness. Anemia is common and has been associated with poor outcomes in the critically ill population, yet the timing and extent of hemoglobin recovery remains incompletely described, which may have important implications for clinical outcomes following discharge from intensive care. To describe longitudinal changes in anemia status during and after critical illness and assess the associations between hemoglobin concentrations and postdischarge mortality. A population-based cohort study was conducted from January 1, 2010, to December 31, 2016, in Olmsted County, Minnesota; data analysis was performed from June 1 to December 30, 2019. Participants included 6901 adults (age ≥18 years) admitted to intensive care. Hemoglobin concentrations in the 12 months before hospitalization, during hospitalization, and in the 12 months after discharge, categorized by anemia severity (mild, hemoglobin ≥10.0 to <12.0 g/dL in women or ≥10.0 to <13.5 g/dL in men; moderate, hemoglobin ≥8.0 to <10.0 g/dL; and severe, hemoglobin <8.0 g/dL). Complete recovery from anemia, defined as attainment of nonanemic status by 12 months post hospitalization, and 12-month mortality were also evaluated. Of the 6901 patients included in the study, 3792 were men (55%); median (interquartile range [IQR]) age was 67 (IQR, 52-79) years. Prehospitalization hemoglobin concentrations were available in 83% of the population (n = 5694), with median hemoglobin concentrations of 13.1 (IQR, 11.6-14.4) g/dL. Forty-one percent of the patients (n = 2320) had anemia preceding hospitalization. Hemoglobin values at hospital discharge were 10.8 g/dL (IQR, 9.5-12.4 g/dL), with 80% (n = 5182 of 6460) having anemia: 58% mild, 39% moderate, and 3% severe. The prevalence of anemia post hospitalization was 56% (95% CI, 55%-58%) at 3 months, 52% (95% CI, 50%-54%) at 6 months, and 45% (95% CI, 43%-47%) at 12 months among those alive with available hemoglobin measurements. Rates of complete recovery from anemia at 12 months were 58% (95% CI, 56%-61%) for mild anemia, 39% (95% CI, 36%-42%) for moderate anemia, and 24% (95% CI, 15%-34%) for severe anemia. Of those without baseline anemia surviving hospitalization, 74% of the patients were anemic at hospital discharge, with rates of complete 12-month recovery of 73% (95% CI, 69%-76%) for mild anemia, 62% (95% CI, 57%-68%) for moderate anemia, and 59% (95% CI, 35%-82%) for severe anemia. Higher hospital discharge hemoglobin concentrations were associated with decreased mortality after multivariable adjustment (hazard ratio, 0.95 per 1-g/dL increase; 95% CI, 0.90-0.99, P = .02). The findings of this study suggest that anemia is common and often persistent in the first year after critical illness. Further studies are warranted to identify distinct anemia recovery profiles and assess associations with clinical outcomes. This cohort study examines the presence of anemia in critically ill patients and outcomes after discharge.
登录
查看更多内容
影响因子：
2.9
作者：
Fukushima, Takuya;Nakano, Jiro;Okita, Minoru
通讯作者：
Okita, Minoru
影响因子：
8.8
作者：
Corwin, HL;Gettinger, A;Shapiro, MJ
通讯作者：
Shapiro, MJ
影响因子：
39.2
作者：
von Elm, Erik;Altman, Douglas G.;Vandenbroucke, Jan P.
通讯作者：
Vandenbroucke, Jan P.
DOI：
10.1111/j.1532-5415.2005.00491.x
发表时间：
2005-12-01
影响因子：
6.3
作者：
Penninx, BWJH;Pluijm, SMF;Deeg, DJH
通讯作者：
Deeg, DJH
影响因子：
14.6
作者：
den Elzen, Wendy P. J.;Willems, Jorien M.;Gussekloo, Jacobijn
通讯作者：
Gussekloo, Jacobijn