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

Yıl 2021, Cilt: 12 Sayı: 2, 166 - 170, 30.06.2021

Büşra Tezcan , Halis Çiftçi

https://doi.org/10.18663/tjcl.922747

Öz

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

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Madabhavi I, Sarkar M, Kadakol N. COVID-19: a review. Monaldi Arch Chest Dis 2020; 90: 248-58.
• 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.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.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.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.World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity; World Health Organization: Geneva, Switzerland, 2011.
• 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. 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.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.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. 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.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. 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.Hariyanto TI, Kurniawan A.Anemia is associated with severe coronavirus disease 2019 (COVID-19) infection.Transfus Apher Sci 2020; 59: 102926.
• 15.Weiss, G, Ganz, T. Goodnough, L.T. Anemia of inflammation. Blood 2019; 133: 40–50.
• 16. Stauder, R, Valent, P, Theurl, I. Anemia at older age: Etiologies, clinical implications, and management.Blood 2018; 131: 505–14.
• 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. 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