Complete recovery from anemia, defined as attainment of nonanemic status by 12 months post hospitalization, and month mortality were also evaluated. Hemoglobin values at hospital discharge were Higher hospital discharge hemoglobin concentrations were associated with decreased mortality after multivariable adjustment hazard ratio, 0.
Conclusions and Relevance The findings of this study suggest that anemia is common and often persistent in the first year after critical illness. Further studies are warranted to identify distinct anemia recovery profiles and assess associations with clinical outcomes. Anemia is a well-known complication of critical illness. Despite the high prevalence of anemia during critical illness, longitudinal data profiling anemia development and subsequent recovery are lacking.
While many critically ill patients are anemic at the time of ICU admission, 17 - 19 it is unclear whether anemia develops abruptly during hospital admission or insidiously before hospitalization, which may have implications for the early identification of high-risk patients before the development of critical illness.
Furthermore, data regarding the resolution or persistence of anemia beyond the initial hospital encounter are limited, 20 representing a gap in our understanding of recovery from critical illness. In this population-based investigation, we examined longitudinal changes in hemoglobin concentrations before, during, and after critical illness and assessed the associations between hospital discharge hemoglobin concentrations and posthospitalization mortality.
Moreover, we assessed differences in anemia recovery based on the severity of anemia at hospital discharge, which is information that will be useful in facilitating future efforts assessing the associations between hemoglobin recovery and post-ICU outcomes. Residents of Olmsted County, Minnesota, were eligible for inclusion, with medical records obtained through the Rochester Epidemiology Project, a comprehensive epidemiologic database of population health information.
For patients surviving critical illness, an independent hospital discharge hemoglobin concentration ie, the last hemoglobin concentration measured before hospital discharge must have been obtained in the 5 days before discharge. Survivors missing either of these measurements were excluded, as a principal study objective was to assess changes in hemoglobin concentrations during hospitalization and patients with only a single hemoglobin assessment would be unlikely representative of true critical illness.
Only the first hospitalization with an ICU admission was included for each patient, such that no patients were included more than once. This was a population-based cohort study conducted under institutional review board approvals from the Mayo Clinic and Olmsted Medical Center with waived requirement for written informed consent given minimal patient risk, although consistent with Minnesota statute The primary outcomes were changes in hemoglobin concentrations and the prevalence of anemia at 3, 6, and 12 months after hospital discharge.
Anemia was defined by hemoglobin values less than Additional outcomes included the prevalence of baseline anemia preceding hospitalization, identified using the most recent hemoglobin concentration measurement preceding hospital admission within 12 months ; the rate of incident hospital-acquired anemia; changes in hemoglobin concentrations from hospital admission to hospital discharge and ICU admission to ICU discharge; hemoglobin recovery or persistence in the first 12 months after hospital discharge, with complete recovery defined as attainment of nonanemic status; and month posthospitalization all-cause mortality as ascertained through Minnesota Department of Health and National Death Index records.
The primary variables of interest were blood hemoglobin concentrations obtained in the 12 months before hospitalization, during hospitalization with associated critical illness, and in the 12 months after hospitalization. All hemoglobin measurements were extracted using the Rochester Epidemiology Project data repository, which includes all measurements obtained during inpatient, outpatient, and emergency health care encounters in southeastern Minnesota and western Wisconsin 27 counties.
Data analysis was conducted from June 1 to December 30, Patient demographic, laboratory, and admission characteristics were summarized as median interquartile range [IQR] for continuous variables and frequency percent for categorical variables according to prehospitalization anemia status. Anemia and mortality rates are summarized as number percent. Given that hemoglobin measurements were not uniformly present in an observational database, not all patients had measurements available at each posthospitalization interval.
Assessments of anemia development and recovery are presented for the full cohort and subgrouped for surgical and nonsurgical patients ie, no surgery during hospitalization. Multivariable Cox proportional hazards regression models were used to assess the associations between hospital discharge hemoglobin concentrations and instantaneous hazard of death in the first year post hospitalization.
Potential confounding variables selected a priori and included in the model were age, sex, admission type, Charlson Comorbidity Index score, admission APACHE III score, ICU length of stay, and prehospitalization anemia status none, mild, moderate, severe, and not available. Schoenfeld residuals were inspected visually to assess the assumption of proportional hazards.
All analyses were performed using SAS, version 9. The median prehospitalization hemoglobin value was Median ICU length of stay was 1. Longitudinal changes in anemia status by prehospitalization anemia status are displayed in Figure 1 and eTable 1 in the Supplement and by type of admission surgical vs nonsurgical in eFigure 2 in the Supplement. There were no substantial changes in median hospital discharge hemoglobin concentrations over time, although the prevalence of severe anemia increased steadily from 1.
Four hundred forty-one patients 6. Patients without follow-up hemoglobin concentration data were generally similar to those with 1 to 5 posthospitalization assessments but were younger without data: Longitudinal changes in anemia status by hospital discharge anemia status for those with available hemoglobin data are displayed in Figure 2 and eTable 5 in the Supplement. Higher discharge hemoglobin concentrations were associated with reduced posthospitalization mortality HR, 0. At 12 months post hospitalization, nearly half of critical illness survivors with available hemoglobin concentration data remained anemic, including more than one-quarter of survivors without prehospitalization anemia.
Higher hospital discharge hemoglobin concentrations were associated with reduced postdischarge mortality. Beyond this work, there is a paucity of data regarding recovery from anemia in survivors of critical illness. This inflammatory state has been proposed as a possible factor associated with delayed recovery of physical function after critical illness, 26 and anemia has also been associated with reduced physical function ambulatory capacity and activities of daily living in critical illness survivors.
First, your doctor will take your family and medical history. Then they will do a physical exam to look for symptoms of anemia. After that, your doctor will draw blood for several tests. The most common are:. For example, they might do a bone marrow test to see how well your body makes red blood cells, look for internal bleeding , or scan for tumors. Treating severe anemia takes more than just diet and lifestyle changes, although eating a healthy diet with lots of iron can help keep you healthy.
In all types of anemia, blood transfusions can help replace your lost or defective red blood cells and reduce symptoms. However, it usually does not address the underlying cause. In this procedure, your bone marrow is replaced with donor marrow that can make healthy cells. Anemia in general causes 1. It is usually treatable if caught quickly, although some types are chronic, which means they need continual treatment. What is a hematologist? This type of doctor specializes in conditions of the blood and immune system.
You may be referred to a hematologist if your…. If you're not getting enough iron, you may develop iron-deficiency anemia. Here are 10 signs and symptoms that you're deficient in iron. Iron is essential for good health, but many people are deficient in it.
The foods you eat can influence how much iron your body ends up absorbing. Eating ice cubes may be one of your dog's favorite activities, but for you it could indicate a medical problem.
Losing large amounts of blood suddenly can create two problems:. Blood pressure falls Low Blood Pressure Low blood pressure is blood pressure low enough to cause symptoms such as dizziness and fainting. Very low blood pressure can cause damage to organs, a process called shock. Various drugs and Either problem may lead to a heart attack Acute Coronary Syndromes Heart Attack; Myocardial Infarction; Unstable Angina Acute coronary syndromes result from a sudden blockage in a coronary artery.
This blockage causes unstable angina or heart attack myocardial infarction , depending on the location and amount Far more common than a sudden loss of blood is long-term chronic bleeding, which may occur from various parts of the body. Although large amounts of bleeding, such as that from nosebleeds and hemorrhoids, are obvious, small amounts of bleeding may not be noticed. For example, a small amount of blood may not be visible in the stool.
This type of blood loss is described as occult hidden. If a small amount of bleeding continues for a long time, a significant amount of blood may be lost. Such gradual bleeding may occur with common disorders, such as ulcers Peptic Ulcer Disease A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices.
Peptic ulcers can result from Helicobacter pylori The cause of diverticulosis is unknown but may be related to diet, a sedentary Some polyps are caused by hereditary conditions.
Bleeding from the rectum is the most common Typical symptoms include bleeding during a bowel movement, fatigue, and weakness Other sources of chronic bleeding include kidney tumors Kidney Cancer Kidney cancer may cause blood in the urine, pain in the side, or fever. No patients developed iron, vitamin B12 or folate deficiency. An inappropriately low erythropoietin response to anemia was observed in virtually all patients and did not distinguish nonrecovering patients.
Patients with delayed recovery or persisting anemia during the 13 wks following ICU discharge had higher levels of circulating inflammatory markers IL-6 and C-reactive protein and did not exhibit reticulocytosis during the weeks following discharge.
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