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. 2021 Mar;59(2):187-193.
doi: 10.1016/j.resinv.2020.10.009. Epub 2020 Nov 23.

Decrease in hemoglobin level predicts increased risk for severe respiratory failure in COVID-19 patients with pneumonia

Moriyasu Anai  1 , Kimitaka Akaike  2 , Hajime Iwagoe  3 , Takefumi Akasaka  4 , Takushi Higuchi  5 , Aoi Miyazaki  1 , Daiki Naito  1 , Yuka Tajima  1 , Hiroshi Takahashi  6 , Taiyo Komatsu  1 , Aiko Masunaga  1 , Hiroto Kishi  6 , Kazuhiko Fujii  6 , Koichiro Fukuda  6 , Yusuke Tomita  7 , Sho Saeki  7 , Hidenori Ichiyasu  7 , Takuro Sakagami  7
Affiliations

Decrease in hemoglobin level predicts increased risk for severe respiratory failure in COVID-19 patients with pneumonia

Moriyasu Anai et al. Respir Investig. 2021 Mar.

Abstract

Background: In December 2019, the coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread throughout the world. This study aimed to investigate the association between the change in laboratory markers during the three days after pneumonia diagnosis and severe respiratory failure in COVID-19 patients.

Methods: Data of 23 COVID-19 patients with pneumonia, admitted to the Kumamoto City Hospital between February and April 2020 were retrospectively analyzed.

Results: Among the 23 patients, eight patients received mechanical ventilation (MV) (MV group), and the remaining 15 comprised the non-MV group. The levels of hemoglobin (Hb) and albumin (Alb) decreased in the MV group during the three days after pneumonia diagnosis more than in the non-MV group (median Hb: 1.40 vs. -0.10 g/dL, P = 0.015; median Alb: 0.85 vs. -0.30 g/dL, P = 0.020). Univariate logistic regression analysis showed that the decrease in Hb was associated with receiving MV care (odds ratio: 0.313, 95% confidence interval: 0.100-0.976, P = 0.045). Receiver operating characteristic curve analyses showed that the optimal cut-off value for the decrease in Hb level was -1.25 g/dL, with sensitivity and specificity values of 0.867 and 0.750, respectively.

Conclusions: The decrease in Hb level during the short period after pneumonia diagnosis might be a predictor of worsening pneumonia in COVID-19 patients.

Keywords: Albumin; Coronavirus disease 2019; Hemoglobin; Intermittent positive pressure ventilation; Severe acute respiratory syndrome coronavirus-2.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The time from onset of illness to MV initiation (A), and the diagnosis of pneumonia (B). MV, mechanical ventilation.
Fig. 2
Fig. 2
Association between MV care and the change in Hb (A) and Alb (B) levels over the short period after the diagnosis of pneumonia. MV; mechanical ventilation, Hb; hemoglobin, Alb; albumin.
Fig. 3
Fig. 3
ROC curve for the change in Hb as a predictor for receiving MV care. The AUC was 0.813 (95% CI: 0.629–0.996) and the optimal cut-off value for predicting receiving MV care was −1.25 (sensitivity 86.7%; specificity 75.0%). ROC; receiver operating characteristic, AUC; area under the curve, CI; confidence interval, MV; mechanical ventilation.
See this image and copyright information in PMC

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