Bateman Anthony P, McArdle Fiona, Walsh Timothy S
New Edinburgh Royal Infirmary, Little France Crescent, Edinburgh, Scotland, UK.
Crit Care Med. 2009 Jun;37(6):1906-12. doi: 10.1097/CCM.0b013e3181a000cf.
Anemia is a common complication of critical illness, but its duration after intensive care discharge and possible contributory factors have not been studied. Our aim was to follow patients discharged anemic from the intensive care unit (ICU) for up to 6 months and determine the duration of and possible reasons for persisting anemia.
Prospective observational cohort study of intensive care (ICU) survivors with moderate-severe anemia at the time of ICU discharge. Erythropoietic and inflammatory markers were measured at regular intervals over six months to assess red cell production and factors limiting recovery from anemia.
An 18-bed medico-surgical ICU in a Scottish university teaching hospital.
Patients who required >24 hrs of ventilatory support and were discharged from intensive care with hemoglobin < 100 g/L were studied prospectively over 6 months. 30 patients were recruited; 19 completed 6 months follow-up, 6 died during the study period, and 5 completed part of the follow up. Patients with ongoing renal failure or chronic hematologic disorders were excluded.
47% (9 of 19) of patients completing 6 months follow up recovered from their anemia. The median time to recovery was 11 wks (1, 3 quartiles: 9, 26 wks). 10 patients (53%) were still anemic 6 months after ICU discharge. No patients developed iron, vitamin B12 or folate deficiency. An inappropriately low erythropoietin response to anemia was observed in virtually all patients and did not distinguish nonrecovering patients. Patients with delayed recovery or persisting anemia during the 13 wks following ICU discharge had higher levels of circulating inflammatory markers (IL-6 and C-reactive protein) and did not exhibit reticulocytosis during the weeks following discharge.
Anemia persists in many patients following critical illness and is associated with ongoing inflammation, inappropriate erythropoietin response and poor marrow red cell production.
贫血是危重病的常见并发症，但重症监护出院后贫血持续时间及可能的促成因素尚未得到研究。我们的目的是对从重症监护病房（ICU）出院时贫血的患者进行长达6个月的随访，并确定持续性贫血的持续时间及可能原因。
对ICU出院时患有中度至重度贫血的ICU幸存者进行前瞻性观察队列研究。在6个月内定期测量促红细胞生成和炎症标志物，以评估红细胞生成及限制贫血恢复的因素。
苏格兰一所大学教学医院的一间拥有18张床位的内科-外科ICU。
对需要>24小时通气支持且血红蛋白<100 g/L从重症监护病房出院的患者进行为期6个月的前瞻性研究。招募了30名患者；19名完成了6个月的随访，6名在研究期间死亡，5名完成了部分随访。排除患有持续性肾衰竭或慢性血液系统疾病的患者。
完成6个月随访的患者中有47%（19名中的9名）贫血得到恢复。恢复的中位时间为11周（第1、3四分位数：9、26周）。10名患者（53%）在ICU出院6个月后仍贫血。没有患者出现铁、维生素B12或叶酸缺乏。几乎所有患者对贫血的促红细胞生成素反应均不适当，且无法区分未恢复的患者。在ICU出院后的13周内恢复延迟或持续贫血的患者循环炎症标志物（IL-6和C反应蛋白）水平较高，且在出院后的几周内未出现网织红细胞增多。
许多危重病患者贫血持续存在，且与持续炎症、促红细胞生成素反应不适当及骨髓红细胞生成不良有关。
