6915Mayo Clinic, Rochester, MN, USA.
166672Vitalant Research Institute, San Francisco, CA, USA.
J Intensive Care Med. 2022 Aug;37(8):1067-1074. doi: 10.1177/08850666211069098. Epub 2022 Feb 1.
Anemia is common during critical illness, is associated with adverse clinical outcomes, and often persists after hospitalization. The goal of this investigation is to assess the relationships between post-hospitalization hemoglobin recovery and clinical outcomes after survival of critical illness. This is a population-based observational study of adults (≥18 years) surviving hospitalization for critical illness between January 1, 2010 and December 31, 2016 in Olmsted County, Minnesota, United States with hemoglobin concentrations and clinical outcomes assessed through one-year post-hospitalization. Multi-state proportional hazards models were utilized to assess the relationships between 1-month post-hospitalization hemoglobin recovery and hospital readmission or death through one-year after discharge. Among 6460 patients that survived hospitalization for critical illness during the study period, 2736 (42%) were alive, not hospitalized, and had available hemoglobin concentrations assessed at 1-month post-index hospitalization. Median (interquartile range) age was 69 (56, 80) years with 54% of male gender. Overall, 86% of patients had anemia at the time of hospital discharge, with median discharge hemoglobin concentrations of 10.2 (9.1, 11.6) g/dL. In adjusted analyses, each 1 g/dL increase in 1-month hemoglobin recovery was associated with decreased instantaneous hazard for hospital readmission (HR 0.87 [95% CI 0.84-0.90]; p < 0.001) and lower mortality (HR 0.82 [95% CI 0.75-0.89]; p < 0.001) through one-year post-hospitalization. The results were consistent in multiple pre-defined sensitivity analyses. Impaired early post-hospitalization hemoglobin recovery is associated with inferior clinical outcomes in the first year of survival after critical illness. Additional investigations are warranted to evaluate these relationships.
贫血在危重病中很常见，与不良临床结局相关，并且常常在住院后持续存在。本研究的目的是评估危重病后住院血红蛋白恢复与临床结局之间的关系。这是一项基于人群的观察性研究，纳入了 2010 年 1 月 1 日至 2016 年 12 月 31 日期间在美国明尼苏达州奥姆斯特德县因危重病住院并存活的成年人（≥18 岁），通过住院后 1 年评估血红蛋白浓度和临床结局。多状态比例风险模型用于评估住院后 1 个月时血红蛋白恢复与出院后 1 年内再次住院或死亡之间的关系。在研究期间因危重病住院存活的 6460 例患者中，有 2736 例（42%）在出院后 1 个月时存活、未住院且可评估血红蛋白浓度。中位（四分位距）年龄为 69（56，80）岁，男性占 54%。总体而言，86%的患者在出院时存在贫血，出院时血红蛋白浓度的中位数为 10.2（9.1，11.6）g/dL。在调整分析中，1 个月时血红蛋白恢复每增加 1 g/dL，与再次住院的即时风险降低相关（风险比 0.87 [95%可信区间 0.84-0.90]；p<0.001），与住院后 1 年内的死亡率降低相关（风险比 0.82 [95%可信区间 0.75-0.89]；p<0.001）。在多个预先定义的敏感性分析中结果一致。危重病后早期血红蛋白恢复不良与危重病存活后 1 年内的临床结局不良相关。需要进一步研究来评估这些关系。
