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. 2020 May;109(5):616-627.
doi: 10.1007/s00392-019-01549-0. Epub 2019 Sep 18.

Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

Hamza A Rayes  1 , Saraschandra Vallabhajosyula  1   2 , Gregory W Barsness  2 , Nandan S Anavekar  2 , Ronald S Go  3 , Mrinal S Patnaik  3 , Kianoush B Kashani  1   4 , Jacob C Jentzer  5   6
Affiliations

Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

Hamza A Rayes et al. Clin Res Cardiol. 2020 May.

Abstract

Background: Anemia and elevated red cell distribution width (RDW) or mean corpuscular volume (MCV) are associated with an adverse prognosis in patients with cardiovascular disease and critical illness. Limited data exist regarding these associations in unselected cardiac intensive care unit (CICU) patients.

Methods: Retrospective cohort study of CICU patients between January 1, 2007, and December 31, 2015, with a hemoglobin (Hb) level measured at admission. Multivariable regression was performed to determine predictors of hospital mortality, and Kaplan-Meier analysis was used to determine post-discharge survival.

Results: We included 9644 patients with a mean age of 67.5 ± 15.1 years, including 3604 (37.4%) females. The median (IQR) values of Hb, MCV and RDW were 12.2 g/dL (10.6, 13.7), 90.7 fL (87.3, 94.2) fL, and 14.1% (13.3, 15.8), respectively. Anemia (admission Hb < 12 g/dL) was present in 4434 (46%) patients. A total of 845 (8.8%) patients died in the hospital. Patients with anemia had higher hospital mortality (11.3% vs. 6.6%, unadjusted OR 1.82, 95% CI 1.58-2.10, p < 0.001). After multivariable regression, admission Hb and MCV were not significantly associated with hospital mortality (both p > 0.1), while admission RDW (adjusted OR 1.12 per 1%, 95% CI 1.07-1.18, p < 0.001) was significantly associated with hospital mortality. Hospital survivors with lower Hb, higher MCV, or higher RDW had lower post-discharge survival.

Conclusion: Elevated RDW on admission was independently associated with higher hospital mortality in CICU patients. These data emphasize the importance of hematologic abnormalities for mortality risk stratification in CICU populations.

Keywords: Anemia; Cardiac intensive care unit; Coronary care unit; Mean corpuscular volume; Mortality; Red cell distribution width.

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Conflict of interest statement

The authors report no relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
CICU and hospital mortality as a function of admission hemoglobin. p < 0.001 for both CICU and hospital mortality across groups using Chi-squared test. CICU cardiac intensive care unit
Fig. 2
Fig. 2
a CICU and hospital mortality as a function of admission MCV. p < 0.001 for both CICU and hospital mortality across groups using Chi-squared test. CICU cardiac intensive care unit, MCV mean corpuscular volume. b CICU and hospital mortality in patients with microcytosis (MCV < 80 fL), macrocytosis (MCV > 100 fL) and normocytosis (MCV 80–100 fL), with and without anemia. p < 0.001 for both CICU and hospital mortality between groups using Chi-squared test. CICU cardiac intensive care unit, MCV mean corpuscular volume
Fig. 3
Fig. 3
Hospital mortality as a function of admission RDW decile in the overall population, patients with anemia, and patients without anemia. p < 0.001 for hospital mortality trends across RDW declines in each group. RDW red cell distribution width
Fig. 4
Fig. 4
a Kaplan–Meier curves demonstrating post-hospital survival among hospital survivors, grouped by admission hemoglobin quartile, based on a median of 12.2 (IQR 10.6–13.7) g/dL. p < 0.001 between groups by log-rank. b Kaplan–Meier curves demonstrating post-hospital survival among hospital survivors, grouped by RDW quartile based on a mean RDW of 14.1% (IQR 13.3–15.6). p < 0.001 between groups by log-rank. RDW, red cell distribution width. c Kaplan–Meier curves demonstrating post-hospital survival among hospital survivors, grouped by admission MCV and the presence of anemia (admission hemoglobin < 12 g/dL). p < 0.001 between groups by log-rank. MCV mean corpuscular volume
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References

    1. Lawler PR, Filion KB, Dourian T, Atallah R, Garfinkle M, Eisenberg MJ. Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis. Am Heart J. 2013;165(2):143–153 e145. doi: 10.1016/j.ahj.2012.10.024. - DOI - PubMed
    1. Kajimoto K, Sato N, Takano T, Investigators of the Acute Decompensated Heart Failure Syndromes r Association between anemia, clinical features and outcome in patients hospitalized for acute heart failure syndromes. Eur Heart J Acute Cardiovasc Care. 2015;4(6):568–576. doi: 10.1177/2048872614554199. - DOI - PubMed
    1. Kwok CS, Tiong D, Pradhan A, Andreou AY, Nolan J, Bertrand OF, Curzen N, Urban P, Myint PK, Zaman AG, et al. Meta-analysis of the prognostic impact of anemia in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2016;118(4):610–620. doi: 10.1016/j.amjcard.2016.05.059. - DOI - PubMed
    1. Brener SJ, Mehran R, Dangas GD, Ohman EM, Witzenbichler B, Zhang Y, Parvataneni R, Stone GW. Relation of baseline hemoglobin levels and adverse events in patients with acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage strategY and Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction Trials) Am J Cardiol. 2017;119(11):1710–1716. doi: 10.1016/j.amjcard.2017.02.052. - DOI - PubMed
    1. Backhaus T, Fach A, Schmucker J, Fiehn E, Garstka D, Stehmeier J, Hambrecht R, Wienbergen H. Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry. Clin Res Cardiol. 2018;107(5):371–379. doi: 10.1007/s00392-017-1192-0. - DOI - PubMed