Ong Adrian W, Muller Alison, Sigal Adam, Fernandez Forrest
Am Surg. 2019 Jul 1;85(7):708-711.
Few studies have evaluated outcomes in geriatric trauma patients discharged with anemia. Our hypothesis was that anemia at discharge was not associated with six-month mortality. A 22-month retrospective study of trauma patients ≥ 65 years was conducted from 2015 to 2016. The end point was six-month mortality. The degree of anemia at admission (admission hemoglobin [AHb]) and discharge (discharge hemoglobin [DHb]) was categorized as follows based on hemoglobin (Hb) (g/dL): I (>10), II (>9 and ≤10), III (>8 and ≤9), and IV (≤8). Univariate analysis and multivariate analysis were performed to determine the association of AHb and DHb with the end point. Nine hundred forty-nine patients were analyzed (median age, 82 years). Six-month mortality was 11 per cent. Mortality was associated with AHb by univariate analysis (I: 10% [84/831]; II: 13% [9/67]; III: 22% [7/32]; and IV: 26% [5/19]) ( = 0.003). DHb was not associated with mortality (I: 11% [65/613]; II: 12% [21/183]; III: 10% [12/116]; and IV: 18% [7/39]) ( = 0.37). Logistic regression found that AHb category IV, age, and chronic kidney disease were independently associated with the end point. In geriatric patients, the severity of anemia at admission and not at discharge predicted six-month mortality. Discharging patients with an Hb of ≤8 g/dL was not adversely associated with mortality.
很少有研究评估贫血出院的老年创伤患者的预后。我们的假设是出院时的贫血与六个月死亡率无关。2015年至2016年对年龄≥65岁的创伤患者进行了一项为期22个月的回顾性研究。终点是六个月死亡率。根据血红蛋白（Hb）（g/dL）将入院时（入院血红蛋白[AHb]）和出院时（出院血红蛋白[DHb]）的贫血程度分类如下：I（>10）、II（>9且≤10）、III（>8且≤9）和IV（≤8）。进行单因素分析和多因素分析以确定AHb和DHb与终点的关联。对949例患者进行了分析（中位年龄82岁）。六个月死亡率为11%。单因素分析显示死亡率与AHb相关（I：10%[84/831]；II：13%[9/67]；III：22%[7/32]；IV：26%[5/19]）（P = 0.003）。DHb与死亡率无关（I：11%[65/613]；II：12%[21/183]；III：10%[12/116]；IV：18%[7/39]）（P = 0.37）。逻辑回归发现AHb类别IV、年龄和慢性肾脏病与终点独立相关。在老年患者中，入院时而非出院时的贫血严重程度可预测六个月死亡率。出院时血红蛋白≤8 g/dL的患者与死亡率无不良关联。
