Early Post-Hospitalization Hemoglobin Recovery and Clinical Outcomes in Survivors of Critical Illness: A Population-Based Cohort Study.
Early Post-Hospitalization Hemoglobin Recovery and Clinical Outcomes in Survivors of Critical Illness: A Population-Based Cohort Study.
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DOI：
10.1177/08850666211069098
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发表时间：
2022-08
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
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贫血在危重疾病期间很常见，与不良的临床结果相关，并且通常在住院后持续存在。本研究的目的是评估住院后血红蛋白恢复与危重病生存后临床结果之间的关系。这是一项基于人群的观察性研究，研究对象为 2010 年 1 月 1 日至 2016 年 12 月 31 日期间美国明尼苏达州奥姆斯特德县因危重病住院的成年人（≥18 岁），通过住院后一年评估血红蛋白浓度和临床结果。利用多州比例风险模型来评估出院后 1 个月血红蛋白恢复与出院后一年内再次入院或死亡之间的关系。在研究期间因危重病住院的 6,460 名患者中，2,736 名（42%）仍然活着，没有住院，并且在住院后 1 个月评估了可用的血红蛋白浓度。中位年龄（四分位距）为 69 (56, 80) 岁，其中男性占 54%。总体而言，86% 的患者出院时患有贫血，出院血红蛋白浓度中位数为 10.2 (9.1, 11.6) g/dL。在调整分析中，1个月血红蛋白恢复每增加1 g/dL，与住院后一年内再入院的瞬时风险降低（HR 0.87 [95% CI 0.84 – 0.90]；p<0.001）和较低的死亡率（HR 0.82 [95% CI 0.75 – 0.89]；p<0.001）相关。多个预定义的敏感性分析的结果是一致的。住院后早期血红蛋白恢复受损与危重病后第一年生存期较差的临床结果相关。需要进行额外的调查来评估这些关系。
Anemia is common during critical illness, is associated with adverse clinical outcomes, and often persists after hospitalization. The goal of this investigation is to assess the relationships between post-hospitalization hemoglobin recovery and clinical outcomes after survival of critical illness. This is a population-based observational study of adults (≥18 years) surviving hospitalization for critical illness between January 1, 2010 and December 31, 2016 in Olmsted County, Minnesota, United States with hemoglobin concentrations and clinical outcomes assessed through one-year post-hospitalization. Multi-state proportional hazards models were utilized to assess the relationships between 1-month post-hospitalization hemoglobin recovery and hospital readmission or death through one-year after discharge. Among 6,460 patients that survived hospitalization for critical illness during the study period, 2,736 (42%) were alive, not hospitalized, and had available hemoglobin concentrations assessed at 1-month post-index hospitalization. Median (interquartile range) age was 69 (56, 80) years with 54% of male gender. Overall, 86% of patients had anemia at the time of hospital discharge, with median discharge hemoglobin concentrations of 10.2 (9.1, 11.6) g/dL. In adjusted analyses, each 1 g/dL increase in 1-month hemoglobin recovery was associated with decreased instantaneous hazard for hospital readmission (HR 0.87 [95% CI 0.84 – 0.90]; p<0.001) and lower mortality (HR 0.82 [95% CI 0.75 – 0.89]; p<0.001) through one-year post-hospitalization. The results were consistent in multiple pre-defined sensitivity analyses. Impaired early post-hospitalization hemoglobin recovery is associated with inferior clinical outcomes in the first year of survival after critical illness. Additional investigations are warranted to evaluate these relationships.
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DOI：
10.1016/s0140-6736(20)31539-7
发表时间：
2020-10-24
期刊：
Lancet (London, England)
影响因子：
--
作者：
Richards T;Baikady RR;Clevenger B;Butcher A;Abeysiri S;Chau M;Macdougall IC;Murphy G;Swinson R;Collier T;Van Dyck L;Browne J;Bradbury A;Dodd M;Evans R;Brealey D;Anker SD;Klein A
通讯作者：
Klein A
影响因子：
8.8
作者：
Corwin, HL;Gettinger, A;Shapiro, MJ
通讯作者：
Shapiro, MJ
影响因子：
4.3
作者：
Napolitano, Lena M.
通讯作者：
Napolitano, Lena M.
影响因子：
13.8
作者：
Warner MA;Hanson AC;Frank RD;Schulte PJ;Go RS;Storlie CB;Kor DJ
通讯作者：
Kor DJ
影响因子：
38.9
作者：
Litton, Edward;Baker, Stuart;Webb, Steve
通讯作者：
Webb, Steve