COVID-19’da hangi anemi mortaliteyle ilişkili? Hafif, orta, ciddi?

Abstract

Amaç:COVID-19 hastalarında yoğun bakım (ICU) kabulü sırasında anemi prevalansını, anemi ile mortalite, hastanede ve yoğun bakımda kalış sürelerinin((LOS-H ve LOC-ICU) ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler:Yoğun bakım ihtiyacı olan 288 COVID-19 hastasını retrospektif olarak analiz ettik. Hastalar iki gruba ayrıldı: anemikler ve anemik olmayanlar. Grupların demografik verileri, ICU kabulleri sırasındaki labaratuar bulguları, LOS-H ve LOS-ICU ve mortaliteleri kıyaslandı. Hemoglobin düzeyleri temel alınarak ileri bir sınıflama yapıldı; ciddi, orta ve hafif anemik hastalar analiz edildi. LOS-H, LOS-ICU ve mortalite hemoglobin düzeyi 109 g/L altındaki ve üstündeki hastalar arasında kıyaslandı. Böylece orta ve ciddi anemik hastalarla hafif anemikler ve anemik olmayanlar karşılaştırıldı. Bulgular:Yoğun bakım kabulü sırasında 137 hastada (%47,6) anemi saptandı. Bunların 54’ünün (%39,4) hafif, 76’sının (%55,5) orta, 7’sinin (%5,1) ağır anemisi vardı. Anemik hastalar daha yaşlı, çoklu komorbiditeye sahip, daha düşük hemoglobin ve albümin, daha yüksek kırmızı küre dağılım genişliği(RDW), kreatinin ve prokalsitonin düzeylerine sahipti. LOS-H , LOS-ICU ve mortalite oranları anemik olan ve olmayan hastalar arasında anlamlı olarak fark göstermezken, hemoglobin düzeyleri ≤ 109 g/L hastalarda (orta ve ağır anemikler) mortalite oranları hemoglobin düzeyleri > 109 g/L (hafif anemikler ve anemik olmayanlar) göre anlamlı olarak yüksekti. LOS-H ve LOS-ICU bu hasta gruplarında anlamlı fark göstermedi. Sadece yedi hastanın ağır anemisi vardı ve bunların tamamı öldü Sonuç:Bu çalışmanın sonuçları; yoğun bakımdaki COVID-19 hastalarında anemi prevalansının yüksek ve hafif anemi artmış mortalite ile ilişkili değilken orta ve ağır aneminin artmış mortalite ile ilişkili olduğunu göstermiştir.COVID-19 hastalarında anemik hastaların hemoglobin düzeyleri hastalığın ilerleyişinin erken tespiti için sık monitorize edilmelidir. Anahtar kelimeler: hafif anemi,; mortalite; yoğun bakım; SARS-CoV-2

Keywords

• hafif anemi
• mortalite
• yoğun bakım
• SARS-CoV-2

Which anemia is associated with mortality in COVID-19? Mild, moderate or severe ?

Abstract

Aim:We aimed to investigate the prevalence of anemia at admission to intensive care unit (ICU), association between anemia and mortality, lengths of stay in hospital and ICU (LOS-H and LOS-ICU) in COVID-19 patients. Material and Methods:We retrospectively analyzed the data of 288 COVID-19 patients who needed ICU admission. Patients were divided into two groups: anemic and nonanemic. Demographic data, labaratory findings at ICU admission, LOS-H and LOS-ICU, mortality were compared between groups. A further classification was made based on hemoglobin levels; severe, moderate and mild anemic patients were analyzed. LOS-H, LOS-ICU and mortality were compared between patients with hemoglobin > 109 g/L and ≤ 109 g/L. Thus; moderate and severe anemic patients were compared to mild anemic and nonanemic patients. Results: Anemia was detected in 137 (47.6%) patients upon admission to the ICU. Of those; 54 patients (39.4%) had mild, 76 patients (55.5%) had moderate, 7 patients (5.1%) had severe anemia. Anemic patients were older, had multiple comorbidities, lower hemoglobin and albumin, higher red cell distribution width (RDW), creatinine and procalcitonin levels. While LOS-H, LOS-ICU and mortality rates did not significantly differ between anemic and nonanemic patients; mortality rate was significantly high in patients with hemoglobin levels ≤ 109 g/L (moderate anemic) compared to patients with a hemoglobin level > 109 g/L (mild anemic and nonanemic). LOS-H and LOS-ICU were not significantly different between these patient groups. Only seven patients had severe anemia and all of these died. Conclusion: The results of this retrospective study showed that the anemia prevalence in ICU patients with COVID-19 was high, and mild anemia was not associated with higher mortality rates, while moderate and severe anemia were. Hemoglobin levels of anemic patients with COVID-19 should be closely monitored for timely detecting signs of disease progression.

Keywords

• mild anemia
• mortality
• intensive care
• SARS-CoV-2

References

1. 1. Madabhavi I, Sarkar M, Kadakol N. COVID-19: a review. Monaldi Arch Chest Dis 2020; 90: 248-58.
2. 2.Cecconi M, Piovani D, Brunetta E et al. Early predictors of clinical deterioration in a cohort of 239 patients hospitalized for Covid-19 infection in Lombardy, Italy. J Clin Med 2020; 9: 1548.
3. 3.Guan W-j, Ni Z-y, Hu Y et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–20.
4. 4.Young B, Ong S, Kalimuddin S et al. Singapore Novel Coronavirus Outbreak Research T. EpidemiologicFeatures and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA 2020; 323: 1488–94.
5. 5.Yang X, Yu Y, Xu J et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia inWuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475–81.
6. 6.World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity; World Health Organization: Geneva, Switzerland, 2011.
7. 7.McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and mineral nutrition information system, 1993–2005. Public Health Nutr 2009; 12: 444–54.
8. 8. Benoit JL, Benoit SW, de Oliveira MHS, Lippi G, Henry BM. Anemia and COVID-19: A prospective perspective. J Med Virol 2021; 93: 708-11.

9. 9.Dinevari MF, Somi MH, Majd ES, Farhangi MA, Nikniaz Z. Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran. BMC Infect Dis 2021; 21: 170.
10. 10.Bellmann-Weiler R, Lanser L, Barket R, et al. Prevalence and predictive value of Anemia and Dysregulated Iron homeostasis in patients with COVID-19 infection. J Clin Med 2020; 9: 2429.
11. 11. Saydam BK, Genc RE, Sarac F, Turfan EC. Prevalence of anemia and related factors among women in Turkey . Pak J Med Sci 2017; 33: 433-8.
12. 12.Ryan AS. Iron-deficiency anemia in infant development: implications for growth, cognitive development, resistance to infection, and iron supplementation. Am J Phys Anthropol 1997; 104: 25–62.
13. 13. Cure E, Cure MC. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID19 pandemic. Diabetes Metab Synd. 2020.
14. 14.Hariyanto TI, Kurniawan A.Anemia is associated with severe coronavirus disease 2019 (COVID-19) infection.Transfus Apher Sci 2020; 59: 102926.
15. 15.Weiss, G, Ganz, T. Goodnough, L.T. Anemia of inflammation. Blood 2019; 133: 40–50.
16. 16. Stauder, R, Valent, P, Theurl, I. Anemia at older age: Etiologies, clinical implications, and management.Blood 2018; 131: 505–14.
17. 17.Lippi G, Salvagno G, Guidi G. Red Blood Cell Width is significantly associated with aging and gender. Clin Chem Lab Med. 2014; 52: 197-9.
18. 18. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015; 52: 86-105