Demaret Pierre, Karam Oliver, Tucci Marisa, Lacroix Jacques, Behal Hélène, Duhamel Alain, Lebrun Frédéric, Mulder André, Leteurtre Stéphane
Pediatric Intensive Care Unit, Department of Pediatrics, CHC, Liège, Belgium.
Université de Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, 59000, Lille, France.
Ann Intensive Care. 2017 Oct 24;7(1):107. doi: 10.1186/s13613-017-0328-8.
Anemia is prevalent at pediatric intensive care unit (PICU) admission and incident during PICU stay, but little is known about anemia at PICU discharge . Anemia after critical illness is an important issue because it could impact post-PICU outcome. We aimed to estimate the prevalence of anemia at PICU discharge and to determine its risk markers.
This is an ancillary study of a prospective observational study on transfusion practices conducted in the PICU of a tertiary care children's hospital. All children consecutively admitted to the PICU during a 1-year period were considered for inclusion. Data were prospectively collected from medical charts, except for hemoglobin (Hb) levels at PICU and hospital discharge that were collected retrospectively. Anemia was defined by an Hb concentration below the lower limit of the normal range for age.
Among the 679 children retained for analysis, 390 (57.4%) were anemic at PICU discharge. After multivariate adjustment, anemia at PICU admission was the strongest risk marker of anemia at PICU discharge. The strength of this association varied according to age (interaction): The odds ratio (OR) (95% CI) of anemia at PICU discharge was 4.85 (1.67-14.11) for 1-5-month-old infants anemic versus not anemic at PICU admission, and it was 73.13 (13.43, 398.19) for adolescents anemic versus not anemic at PICU admission. Children admitted after a non-cardiac surgery had an increased risk of anemia at PICU discharge [OR 2.30 (1.37, 3.88), p = 0.002]. The proportion of anemic children differed between age categories, while the median Hb level did not exhibit significant variations according to age.
Anemia is highly prevalent at PICU discharge and is strongly predicted by anemia at PICU admission. The usual age-based definitions of anemia may not be relevant for critically ill children. The consequences of anemia at PICU discharge are unknown and deserve further scrutiny.
贫血在儿科重症监护病房（PICU）入院时很常见，且在PICU住院期间也会发生，但对于PICU出院时的贫血情况知之甚少。危重症后的贫血是一个重要问题，因为它可能影响PICU后的结局。我们旨在估计PICU出院时贫血的患病率，并确定其风险标志物。
这是一项对一家三级儿童专科医院PICU进行的输血实践前瞻性观察研究的辅助研究。所有在1年期间连续入住PICU的儿童均被纳入研究。数据前瞻性地从病历中收集，但PICU和出院时的血红蛋白（Hb）水平是回顾性收集的。贫血定义为Hb浓度低于年龄正常范围下限。
在保留用于分析的679名儿童中，390名（57.4%）在PICU出院时贫血。多因素调整后，PICU入院时贫血是PICU出院时贫血的最强风险标志物。这种关联的强度因年龄而异（交互作用）：1至5个月大的婴儿在PICU入院时贫血与非贫血相比，PICU出院时贫血的比值比（OR）（95%CI）为4.85（1.67至14.11），而青少年在PICU入院时贫血与非贫血相比，该比值比为73.13（13.43，398.19）。非心脏手术后入院的儿童在PICU出院时贫血风险增加[OR 2.30（1.37，3.88），p = 0.002]。贫血儿童的比例在不同年龄组之间有所不同，而Hb中位数水平并未随年龄呈现显著变化。
贫血在PICU出院时非常普遍，且PICU入院时的贫血强烈预示着出院时的贫血情况。通常基于年龄的贫血定义可能不适用于危重症儿童。PICU出院时贫血的后果尚不清楚，值得进一步研究。
