Guinn Nicole R, Cooter Mary L, Villalpando Claudia, Weiskopf Richard B
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Department of Anesthesiology, Garfield Medical Center, Monterey Park, California.
Transfusion. 2018 Oct;58(10):2290-2296. doi: 10.1111/trf.14768. Epub 2018 May 24.
There are limited data on morbidity and mortality in severely anemic patients for whom blood transfusion is not an option, with most data coming only from surgical patients and no data on the rate of myocardial ischemia associated with severe anemia. We sought to determine rates of all-cause mortality and myocardial ischemia in severely anemic hospitalized patients declining transfusion.
With institutional review board approval, we conducted a retrospective review of all hospital admissions for adult blood refusal patients between January 2004 and September 2015 at a single institution. Severe anemia was defined as hemoglobin (Hb) level of not more than 8.0 g/dL at any time during hospital admission. Outcomes measured included all-cause mortality within 30 days of nadir Hb and myocardial ischemia as defined by abnormal troponin (>0.10 ng/mL). We studied the association of patient's nadir Hb with outcomes via multivariable repeated measures generalized estimating equations (GEEs).
Of 1306 blood refusal patients with hospital admissions during the study period, 263 had at least one admission with Hb level of not more than 8.0 g/dL. The rate of all-cause mortality within 30 days was 19.8%, and the multivariable GEE model indicated a 55% increase in odds of mortality per 1 g/dL decrease in nadir Hb (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.25-1.91; p < 0.0001). Rate of myocardial ischemia was 10.5% and in the multivariable model risk increased with decreasing nadir Hb (per 1 g/dL decrease; OR, 1.42; 95% CI, 1.07-1.90; p = 0.016).
Severe anemia is associated with increased myocardial ischemia and mortality in patients declining transfusion, with risk increasing with decreasing nadir Hb.
对于不适合输血的严重贫血患者，关于其发病率和死亡率的数据有限，大多数数据仅来自外科手术患者，且没有关于严重贫血相关心肌缺血发生率的数据。我们试图确定拒绝输血的严重贫血住院患者的全因死亡率和心肌缺血发生率。
经机构审查委员会批准，我们对2004年1月至2015年9月期间一家机构收治的所有拒绝输血的成年患者的住院情况进行了回顾性研究。严重贫血定义为住院期间任何时间血红蛋白（Hb）水平不超过8.0 g/dL。测量的结局包括最低Hb水平后30天内的全因死亡率以及肌钙蛋白异常（>0.10 ng/mL）定义的心肌缺血。我们通过多变量重复测量广义估计方程（GEE）研究患者最低Hb与结局之间的关联。
在研究期间住院的1306例拒绝输血患者中，263例至少有一次住院时Hb水平不超过8.0 g/dL。30天内全因死亡率为19.8%，多变量GEE模型表明最低Hb每降低1 g/dL，死亡几率增加55%（优势比[OR]，1.55；95%置信区间[CI]，1.25 - 1.91；p < 0.0001）。心肌缺血发生率为10.5%，在多变量模型中，风险随最低Hb降低而增加（每降低1 g/dL；OR，1.42；95% CI，1.07 - 1.90；p = 0.016）。
严重贫血与拒绝输血患者的心肌缺血和死亡率增加相关，风险随最低Hb降低而增加。
