Rumpf Florian, Hof Lotta, Old Oliver, Friederich Patrick, Friedrich Jens, Thoma Josef, Wittmann Maria, Zacharowski Kai, Choorapoikayil Suma, Meybohm Patrick
University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
Front Med (Lausanne). 2024 Mar 13;11:1334773. doi: 10.3389/fmed.2024.1334773. eCollection 2024.
Anemia affects humans throughout life, and is linked to higher morbidity and mortality. Unclear is whether hemoglobin values are equivalent between women and men. This study evaluates the association of preoperative hemoglobin levels with in-hospital mortality and estimates thresholds for survival equity between men and women. All adult patients undergoing surgery between 2010 and 2019 from 14 German hospitals were included in the study. Thresholds for survival equity were determined with generalized additive models. In total, 842,130 patients with a median in-hospital follow-up time of 7 days were analyzed. During follow-up 20,370 deaths occurred. Preoperative hemoglobin stratified in-hospital mortality (log-rank test < 0.001) and was associated with mortality independently of demographic risk, surgical risk and health status. For each 1 g/dL reduction in preoperative hemoglobin, the odds of mortality increased by a factor of 1.22 (95% CI 1.21-1.23, < 0.001). A preoperative hemoglobin threshold of 10.5 g/dL reflected equivalent risk for both male and female patients. Hemoglobin levels below 10.5 g/dL had higher risk of mortality for women than for men. The findings from this study aid evidence-based thresholds, inform anemia management and promote equitable care, thus enhancing patient outcomes.
贫血在人的一生中都会产生影响，并与更高的发病率和死亡率相关。目前尚不清楚男性和女性的血红蛋白值是否相等。本研究评估术前血红蛋白水平与住院死亡率之间的关联，并估计男女生存公平性的阈值。研究纳入了2010年至2019年间来自德国14家医院的所有接受手术的成年患者。生存公平性的阈值通过广义相加模型确定。总共分析了842130例患者，住院中位随访时间为7天。随访期间发生了20370例死亡。术前血红蛋白可分层住院死亡率（对数秩检验＜0.001），且与死亡率相关，与人口统计学风险、手术风险和健康状况无关。术前血红蛋白每降低1g/dL，死亡几率增加1.22倍（95%CI 1.21-1.23，＜0.001）。术前血红蛋白阈值为10.5g/dL时，男性和女性患者的风险相当。血红蛋白水平低于10.5g/dL时，女性的死亡风险高于男性。本研究的结果有助于确定基于证据的阈值，为贫血管理提供信息并促进公平护理，从而改善患者预后。
