Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada.
Public Health School, Université de Montréal and Research Center, CHU Sainte-Justine, Montréal, Québec, Canada.
Transfusion. 2023 May;63(5):973-981. doi: 10.1111/trf.17309. Epub 2023 Mar 12.
Restrictive transfusion practices are increasingly being followed in pediatric intensive care units (PICU); consequently, more patients are discharged anemic from PICU. Given the possible impact of anemia on long-term neurodevelopmental outcomes, we aim to describe the epidemiology of anemia at PICU discharge in a mixed (pediatric and cardiac) cohort of PICU survivors and to characterize risk factors for anemia.
We performed a retrospective cohort study in the PICU of a multidisciplinary tertiary-care university-affiliated center. All consecutive PICU survivors for whom a hemoglobin level was available at PICU discharge were included. Baseline characteristics and hemoglobin levels were extracted from an electronic medical records database.
From January 2013 to January 2018, 4750 patients were admitted to the PICU (97.1% survival); discharge hemoglobin levels were available for 4124 patients. Overall, 50.9% (n = 2100) were anemic at PICU discharge. Anemia at PICU discharge was also common in the cardiac surgery population (53.3%), mainly in acyanotic patients; only 24.6% of cyanotic patients were anemic according to standard definitions of anemia. Cardiac surgery patients were transfused more often and at higher hemoglobin levels than medical and non-cardiac surgery patients. Anemia at admission was the strongest predictor of anemia at discharge (odds ratios (OR): 6.51, 95% confidence interval (CI:5.40;7.85)).
Half of PICU survivors are anemic at discharge. Further studies are required to determine the course of anemia after discharge and to ascertain whether anemia is associated with adverse long-term outcomes.
在儿科重症监护病房（PICU）中，越来越多地采用限制性输血策略；因此，更多的患者从 PICU 出院时贫血。鉴于贫血对长期神经发育结局的可能影响，我们旨在描述儿科重症监护病房（PICU）幸存者混合（儿科和心脏）队列中 PICU 出院时贫血的流行病学，并确定贫血的危险因素。
我们在一家多学科三级保健大学附属中心的 PICU 中进行了回顾性队列研究。纳入所有在 PICU 出院时血红蛋白水平可获得的连续 PICU 幸存者。从电子病历数据库中提取基线特征和血红蛋白水平。
2013 年 1 月至 2018 年 1 月，4750 名患者被收入 PICU（97.1%的存活率）；有 4124 名患者出院时血红蛋白水平可获得。总体而言，50.9%（n=2100）在 PICU 出院时贫血。心脏手术患者中贫血也很常见（53.3%），主要见于非发绀患者；仅根据贫血的标准定义，24.6%的发绀患者贫血。心脏手术患者比内科和非心脏手术患者输血更频繁，且输血时的血红蛋白水平更高。入院时贫血是出院时贫血的最强预测因素（比值比（OR）：6.51，95%置信区间（CI）：5.40；7.85））。
一半的 PICU 幸存者在出院时贫血。需要进一步研究以确定出院后贫血的病程，并确定贫血是否与不良长期结局相关。
