Christian Doppler Laboratory on Iron and Phosphate Biology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, University Hospital & Medical University of Innsbruck, Innsbruck, Austria.
PLoS One. 2022 Jul 27;17(7):e0269309. doi: 10.1371/journal.pone.0269309. eCollection 2022.
Anemia is present in up to two-thirds of patients undergoing colorectal surgery mainly caused by iron deficiency and inflammation. As anemia is associated with increased risk of perioperative death, diagnosis and treatment of preoperative anemia according to etiology have been recommended.
The aim of the present study was to assess if the association between anemia and survival in patients undergoing colorectal surgery was determined by the severity of anemia alone or also by anemia etiology.
To determine the prevalence of anemia and etiology, preoperative hematological parameters, C-reactive protein, ferritin and transferrin saturation were retrospectively assessed and correlated with outcome in a cohort of patients undergoing colorectal surgery between 2005 and 2019 at the University Hospital of Innsbruck. Anemia was defined as hemoglobin <120 g/L in females and <130 g/L in males. The etiology of anemia was classified on the basis of serum iron parameters, as iron deficiency anemia, anemia of inflammation or other anemia etiologies.
Preoperative anemia was present in 54% (1316/2458) of all patients. Anemia was associated with iron deficiency in 45% (134/299) and classified as anemia of inflammation in 32% (97/299) of patients with available serum iron parameters. The etiology of anemia was a strong and independent predictor of survival, where iron deficiency and anemia of inflammation were associated with better postoperative survival than other anemia etiologies. One year survival rates were 84.3%, 77.3% and 69.1% for patients with iron deficiency anemia, anemia of inflammation and other anemia types. Inflammation indicated by high C-reactive protein is a strong negative predictor of overall survival.
Anemia has a high prevalence among patients undergoing colorectal surgery and rational treatment requires early assessment of serum iron parameters and C-reactive protein.
贫血在接受结直肠手术的患者中高达三分之二，主要由缺铁和炎症引起。由于贫血与围手术期死亡风险增加相关，因此根据病因诊断和治疗术前贫血已被推荐。
本研究旨在评估贫血与结直肠手术患者生存之间的关联是否仅由贫血严重程度决定，还是也由贫血病因决定。
为了确定贫血和病因的患病率，回顾性评估了 2005 年至 2019 年在因斯布鲁克大学医院接受结直肠手术的患者队列的术前血液学参数、C 反应蛋白、铁蛋白和转铁蛋白饱和度，并将其与结局相关联。贫血定义为女性血红蛋白<120g/L，男性血红蛋白<130g/L。根据血清铁参数将贫血病因分类为缺铁性贫血、炎症性贫血或其他贫血病因。
所有患者中术前贫血的发生率为 54%（1316/2458）。贫血与铁缺乏相关，在有可用血清铁参数的患者中，45%（134/299）被归类为缺铁性贫血，32%（97/299）被归类为炎症性贫血。贫血的病因是生存的强有力且独立的预测因子，其中缺铁性贫血和炎症性贫血与术后生存改善相关，而其他贫血病因则较差。缺铁性贫血、炎症性贫血和其他贫血类型的患者一年生存率分别为 84.3%、77.3%和 69.1%。高 C 反应蛋白提示炎症是总生存的强烈负预测因子。
贫血在接受结直肠手术的患者中患病率很高，合理的治疗需要早期评估血清铁参数和 C 反应蛋白。
