Anemia in hospitalized patients: an overlooked risk in medical care

Deepan Krishnasivam, Kevin M. Trentino, Sally Burrows, Shannon L. Farmer, Sherman Picardo, Michael F. Leahy, Abir Halder, Jenny Chamberlain, Stuart Swain, Kalindu Muthucumarana, Grant Waterer

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS: A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in-hospital mortality and LOS. RESULTS: Of 80,765 inpatients, 45,675 (56.55%) had anemia during admission. Mild and moderate/severe anemia were independently associated with increased in-hospital mortality (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.36-1.86, p = 0.001; OR 2.77, 95% CI 2.32-3.30, p < 0.001, respectively). Anemia was also associated with increased LOS, demonstrating a larger effect in emergency (mild anemia—incident rate ratio [IRR] 1.52, 95% CI 1.48-1.56, p < 0.001; moderate/severe anemia—IRR 2.18, 95% CI 2.11-2.26, p < 0.001) compared to elective admissions (mild anemia—IRR 1.30, 95% CI 1.21-1.41, p < 0.001; moderate/severe anemia—IRR 1.69, 95% CI 1.55-1.83, p < 0.001). LOS was longer in patients who developed anemia during admission compared to those who had anemia on admission (IRR 1.13, 95% CI 1.10-1.17, p < 0.001). Red cell transfusion was independently associated with 2.23 times higher odds of in-hospital mortality (95% CI 1.89-2.64, p < 0.001) and 1.31 times longer LOS (95% CI 1.25-1.37, p < 0.001). CONCLUSION: More than one-third of patients not anemic on admission developed anemia during admission. Even mild anemia is independently associated with increased mortality and LOS; however, transfusion to treat anemia is an independent and additive risk factor.

Original languageEnglish
Pages (from-to)2522-2528
Number of pages7
JournalTransfusion
Volume58
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

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Anemia
Confidence Intervals
Length of Stay
Hospital Mortality
Odds Ratio
Western Australia
Mortality
Tertiary Care Centers
Inpatients
Emergencies
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Population

Cite this

Krishnasivam, Deepan ; Trentino, Kevin M. ; Burrows, Sally ; Farmer, Shannon L. ; Picardo, Sherman ; Leahy, Michael F. ; Halder, Abir ; Chamberlain, Jenny ; Swain, Stuart ; Muthucumarana, Kalindu ; Waterer, Grant. / Anemia in hospitalized patients : an overlooked risk in medical care. In: Transfusion. 2018 ; Vol. 58, No. 11. pp. 2522-2528.
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title = "Anemia in hospitalized patients: an overlooked risk in medical care",
abstract = "BACKGROUND: This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS: A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in-hospital mortality and LOS. RESULTS: Of 80,765 inpatients, 45,675 (56.55{\%}) had anemia during admission. Mild and moderate/severe anemia were independently associated with increased in-hospital mortality (odds ratio [OR] 1.5, 95{\%} confidence interval [CI] 1.36-1.86, p = 0.001; OR 2.77, 95{\%} CI 2.32-3.30, p < 0.001, respectively). Anemia was also associated with increased LOS, demonstrating a larger effect in emergency (mild anemia—incident rate ratio [IRR] 1.52, 95{\%} CI 1.48-1.56, p < 0.001; moderate/severe anemia—IRR 2.18, 95{\%} CI 2.11-2.26, p < 0.001) compared to elective admissions (mild anemia—IRR 1.30, 95{\%} CI 1.21-1.41, p < 0.001; moderate/severe anemia—IRR 1.69, 95{\%} CI 1.55-1.83, p < 0.001). LOS was longer in patients who developed anemia during admission compared to those who had anemia on admission (IRR 1.13, 95{\%} CI 1.10-1.17, p < 0.001). Red cell transfusion was independently associated with 2.23 times higher odds of in-hospital mortality (95{\%} CI 1.89-2.64, p < 0.001) and 1.31 times longer LOS (95{\%} CI 1.25-1.37, p < 0.001). CONCLUSION: More than one-third of patients not anemic on admission developed anemia during admission. Even mild anemia is independently associated with increased mortality and LOS; however, transfusion to treat anemia is an independent and additive risk factor.",
author = "Deepan Krishnasivam and Trentino, {Kevin M.} and Sally Burrows and Farmer, {Shannon L.} and Sherman Picardo and Leahy, {Michael F.} and Abir Halder and Jenny Chamberlain and Stuart Swain and Kalindu Muthucumarana and Grant Waterer",
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Krishnasivam, D, Trentino, KM, Burrows, S, Farmer, SL, Picardo, S, Leahy, MF, Halder, A, Chamberlain, J, Swain, S, Muthucumarana, K & Waterer, G 2018, 'Anemia in hospitalized patients: an overlooked risk in medical care' Transfusion, vol. 58, no. 11, pp. 2522-2528. https://doi.org/10.1111/trf.14877

Anemia in hospitalized patients : an overlooked risk in medical care. / Krishnasivam, Deepan; Trentino, Kevin M.; Burrows, Sally; Farmer, Shannon L.; Picardo, Sherman; Leahy, Michael F.; Halder, Abir; Chamberlain, Jenny; Swain, Stuart; Muthucumarana, Kalindu; Waterer, Grant.

In: Transfusion, Vol. 58, No. 11, 01.11.2018, p. 2522-2528.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anemia in hospitalized patients

T2 - an overlooked risk in medical care

AU - Krishnasivam, Deepan

AU - Trentino, Kevin M.

AU - Burrows, Sally

AU - Farmer, Shannon L.

AU - Picardo, Sherman

AU - Leahy, Michael F.

AU - Halder, Abir

AU - Chamberlain, Jenny

AU - Swain, Stuart

AU - Muthucumarana, Kalindu

AU - Waterer, Grant

PY - 2018/11/1

Y1 - 2018/11/1

N2 - BACKGROUND: This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS: A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in-hospital mortality and LOS. RESULTS: Of 80,765 inpatients, 45,675 (56.55%) had anemia during admission. Mild and moderate/severe anemia were independently associated with increased in-hospital mortality (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.36-1.86, p = 0.001; OR 2.77, 95% CI 2.32-3.30, p < 0.001, respectively). Anemia was also associated with increased LOS, demonstrating a larger effect in emergency (mild anemia—incident rate ratio [IRR] 1.52, 95% CI 1.48-1.56, p < 0.001; moderate/severe anemia—IRR 2.18, 95% CI 2.11-2.26, p < 0.001) compared to elective admissions (mild anemia—IRR 1.30, 95% CI 1.21-1.41, p < 0.001; moderate/severe anemia—IRR 1.69, 95% CI 1.55-1.83, p < 0.001). LOS was longer in patients who developed anemia during admission compared to those who had anemia on admission (IRR 1.13, 95% CI 1.10-1.17, p < 0.001). Red cell transfusion was independently associated with 2.23 times higher odds of in-hospital mortality (95% CI 1.89-2.64, p < 0.001) and 1.31 times longer LOS (95% CI 1.25-1.37, p < 0.001). CONCLUSION: More than one-third of patients not anemic on admission developed anemia during admission. Even mild anemia is independently associated with increased mortality and LOS; however, transfusion to treat anemia is an independent and additive risk factor.

AB - BACKGROUND: This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS: A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in-hospital mortality and LOS. RESULTS: Of 80,765 inpatients, 45,675 (56.55%) had anemia during admission. Mild and moderate/severe anemia were independently associated with increased in-hospital mortality (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.36-1.86, p = 0.001; OR 2.77, 95% CI 2.32-3.30, p < 0.001, respectively). Anemia was also associated with increased LOS, demonstrating a larger effect in emergency (mild anemia—incident rate ratio [IRR] 1.52, 95% CI 1.48-1.56, p < 0.001; moderate/severe anemia—IRR 2.18, 95% CI 2.11-2.26, p < 0.001) compared to elective admissions (mild anemia—IRR 1.30, 95% CI 1.21-1.41, p < 0.001; moderate/severe anemia—IRR 1.69, 95% CI 1.55-1.83, p < 0.001). LOS was longer in patients who developed anemia during admission compared to those who had anemia on admission (IRR 1.13, 95% CI 1.10-1.17, p < 0.001). Red cell transfusion was independently associated with 2.23 times higher odds of in-hospital mortality (95% CI 1.89-2.64, p < 0.001) and 1.31 times longer LOS (95% CI 1.25-1.37, p < 0.001). CONCLUSION: More than one-third of patients not anemic on admission developed anemia during admission. Even mild anemia is independently associated with increased mortality and LOS; however, transfusion to treat anemia is an independent and additive risk factor.

UR - http://www.scopus.com/inward/record.url?scp=85054186329&partnerID=8YFLogxK

U2 - 10.1111/trf.14877

DO - 10.1111/trf.14877

M3 - Article

VL - 58

SP - 2522

EP - 2528

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 11

ER -