Landi Francesco, Russo Andrea, Danese Paola, Liperoti Rosa, Barillaro Christian, Bernabei Roberto, Onder Graziano
Department of Gerontology and Geriatrics, Catholic University of Sacred Heart, Roma, Italy.
J Am Med Dir Assoc. 2007 Jun;8(5):322-7. doi: 10.1016/j.jamda.2007.01.028. Epub 2007 May 7.
Anemia status is a typical feature of the "frailty syndrome" of elderly subjects. Increasing evidences suggest that low hemoglobin concentration is common in elderly subjects and adversely affects morbidity and mortality.
In the present study, we evaluate the impact of hemoglobin concentration on the risk of all-cause mortality in a large population of frail and old subjects living in a nursing home.
There were 372 residents admitted to the teaching nursing home of Catholic University of Rome aged 65 years and older from January 2002 to November 2004 who were enrolled. For the present study we selected all the subjects with a full MDS-NH assessment within 14 days after admission. The main outcome measure was the relative hazard ratio of death after 2 years of follow-up for different levels of hemoglobin concentration.
Based on the WHO criteria for anemia, 235 participants were anemic at enrollment (63.1% of the cohort). A total of 130 deaths (44 men and 86 women) occurred during 2-years of follow-up. Death rates for those with and without anemia based on the WHO criteria were 38% and 28%, respectively (P = .03). The age- and sex-adjusted hazard ratio for mortality was 1.56 (95% CI, 1.07-2.28) for persons with anemia. Compared with the lower tertile, the age- and sex-adjusted hazard ratios of mortality for hemoglobin in the second and third tertiles were 0.40 (95% CI, 0.26-0.61), and 0.39 (95% CI, 0.24-0.58), respectively. Adjusting for potential confounders, including markers of frailty, cognitive impairment, creatinine levels, cancer, stroke, body mass index, and pressure ulcer, somewhat reduced the strength of the association between hemoglobin level and mortality, but it remained statistically significant.
Our results obtained from a representative sample of very old and frail elderly subjects living in a nursing home expand the knowledge that high levels of hemoglobin are associated with better survival. Anemia should be actively sought, appropriate diagnostic strategies should be implemented to search for potentially correctable causes, and aggressive interventions may be warranted to reduce mortality and improve functional status.
贫血状态是老年人群“衰弱综合征”的典型特征。越来越多的证据表明，血红蛋白浓度低在老年人群中很常见，并对发病率和死亡率产生不利影响。
在本研究中，我们评估了血红蛋白浓度对大量居住在养老院的体弱老年人全因死亡风险的影响。
纳入了2002年1月至2004年11月期间入住罗马天主教大学教学养老院的372名65岁及以上的居民。在本研究中，我们选择了入院后14天内进行完整MDS-NH评估的所有受试者。主要结局指标是随访2年后不同血红蛋白浓度水平下的相对死亡风险比。
根据世界卫生组织的贫血标准，235名参与者在入组时贫血（占队列的63.1%）。在2年的随访期间共发生130例死亡（44名男性和86名女性）。根据世界卫生组织标准，贫血和非贫血患者的死亡率分别为38%和28%（P = 0.03）。贫血患者年龄和性别调整后的死亡风险比为1.56（95%CI，1.07 - 2.28）。与最低三分位数相比，血红蛋白处于第二和第三三分位数的年龄和性别调整后的死亡风险比分别为0.40（95%CI，0.26 - 0.61）和0.39（95%CI，0.24 - 0.58）。对包括衰弱标志物、认知障碍、肌酐水平、癌症、中风、体重指数和压疮等潜在混杂因素进行调整后，血红蛋白水平与死亡率之间的关联强度有所降低，但仍具有统计学意义。
我们从居住在养老院的非常年老体弱的老年人代表性样本中获得的结果扩展了这样的认识，即高水平的血红蛋白与更好的生存相关。应积极筛查贫血，应实施适当的诊断策略以寻找潜在可纠正的原因，并且可能需要积极干预以降低死亡率并改善功能状态。
