Riva Emma, Tettamanti Mauro, Mosconi Paola, Apolone Giovanni, Gandini Francesca, Nobili Alessandro, Tallone Maria Vittoria, Detoma Paolo, Giacomin Adriano, Clerico Mario, Tempia Patrizia, Guala Adriano, Fasolo Gilberto, Lucca Ugo
Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
Haematologica. 2009 Jan;94(1):22-8. doi: 10.3324/haematol.13449. Epub 2008 Nov 10.
Mild anemia is a frequent laboratory finding in the elderly usually disregarded in everyday practice as an innocent bystander. The aim of the present population-based study was to prospectively investigate the association of mild grade anemia with hospitalization and mortality.
A prospective population-based study of all 65 to 84 year old residents in Biella, Italy was performed between 2003 and 2007. Data from a total of 7,536 elderly with blood tests were available to estimate mortality; full health information available to evaluate health-related outcomes was available for 4,501 of these elderly subjects. Mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men.
The risk of hospitalization in the 3 years following recruitment was higher among the mildly anemic elderly subjects than among subjects who were not anemic (adjusted hazard ratio: 1.32; 95% confidence interval: 1.09-1.60). Mortality risk in the following 3.5 years was also higher among the mildly anemic elderly (adjusted hazard ratio: 1.86; 95% confidence interval: 1.34-2.53). Similar results were found when slightly elevating the lower limit of normal hemoglobin concentration to 12.2 g/dL in women and to 13.2 g/dL in men. The risk of mortality was significantly increased in mild anemia of chronic disease but not in that due to beta-thalassemia minor.
After controlling for many potential confounders, mild grade anemia was found to be prospectively associated with clinically relevant outcomes such as increased risk of hospitalization and all-cause mortality. Whether raising hemoglobin concentrations can reduce the risks associated with mild anemia should be tested in controlled clinical trials.
轻度贫血在老年人中是常见的实验室检查结果，在日常医疗实践中通常被视为无害的伴随情况而被忽视。本基于人群的研究旨在前瞻性地调查轻度贫血与住院及死亡率之间的关联。
2003年至2007年间，对意大利比耶拉所有65至84岁居民进行了一项基于人群的前瞻性研究。共有7536名进行过血液检测的老年人的数据可用于估计死亡率；其中4501名老年人有完整的健康信息可用于评估与健康相关的结局。轻度贫血定义为女性血红蛋白浓度在10.0至11.9 g/dL之间，男性在10.0至12.9 g/dL之间。
招募后3年内，轻度贫血的老年受试者住院风险高于非贫血受试者（调整后风险比：1.32；95%置信区间：1.09 - 1.60）。在接下来的3.5年中，轻度贫血的老年人死亡风险也更高（调整后风险比：1.86；95%置信区间：1.34 - 2.53）。当将女性血红蛋白浓度正常下限略微提高到12.2 g/dL，男性提高到13.2 g/dL时，也得到了类似结果。慢性病所致轻度贫血患者的死亡风险显著增加，而轻度β地中海贫血所致者则不然。
在控制了许多潜在混杂因素后，发现轻度贫血与住院风险增加和全因死亡率等临床相关结局存在前瞻性关联。是否提高血红蛋白浓度可降低与轻度贫血相关的风险，应在对照临床试验中进行检验。
