Anaemia among intensive care unit survivors and association with days alive and at home: an observational study

Abstract

Summary Anaemia is highly prevalent at the time of intensive care unit discharge and is persistent for a high proportion of intensive care unit survivors. Whether anaemia is a driver of impaired recovery after critical illness is uncertain. The aim of this study was to test the hypothesis that, in adult intensive care survivors, anaemia at the time of intensive care unit discharge independently predicts decreased days at home‐90. This retrospective cohort study was conducted in a tertiary intensive care unit in Perth, Western Australia. All patients aged ≥ 16 years, discharged alive from their index intensive care unit admission and without documented treatment limitations were included. Median (IQR [range]) age of the 6358 participants was 61 (46–72 [16–95]) years and included 3385 (53.2%) unplanned admissions. Intensive care unit discharge with a haemoglobin concentration < 100 g.l‐1 occurred in 2886 (45.4%) patients, a threshold that identified a cohort with significantly lower days at home‐90 (median (IQR [range]) 80 (64–85 [0–90]) days vs. 85 (77–88 [0–90]) days (median difference 5 days, 95%CI 4.4–5.5, p < 0.0001). The association followed a severity‐response relationship with more severe anaemia predicting lower days at home‐90. When accounting for prespecified covariates including admission haemoglobin concentration and red blood cell transfusion, anaemia at intensive care unit discharge remained a significant predictor of decreased days at home‐90, relative risk 0.96 (0.93–0.98), p < 0.002. These findings support the need for interventional trials investigating whether this risk is modifiable.

Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss

“…The consequences of anemia in this patient population are severe compared to non-intensive care patients [68]. In a retrospective study from Van der Laan et al, the presence of anemia at ICU discharge was an independent risk factor for a worse outcome [69]. Additionally, an observational study by Smilowitz et al, including >3000 patients, identified anemia as a predictor of reduced long-term survival [70].…”

Week-One Anaemia was Associated with Increased One-Year Mortality in Critically Ill Surgical Patients

“…Similarly, van der Laan et al analysing 6,358 ICU survivors, mainly discharged from surgical ICU (60.7%, 3860/6358), in Western Australia, found that 45.4% (2,886/6,358) of patients had anaemia (<10 g/dL), which correlated with decreased days at home till day-90 (Relative risk 0.96, 95% CI 0.93-0.98). [4] Notably, anaemia in critically ill patients appears to be a lasting issue. Warner et al analysed levels of haemoglobin at 3-month, 6-month, and 12-month after ICU discharge among 6,901 critically ill patients in Minnesota and reported that the prevalence of anaemia at 3-month, 6-month, and 12-month were 56%, 52%, and 45%, respectively [21].…”

“…Anaemia is a highly prevalent comorbidity in critically ill surgical patients, and it is estimated that approximately 50% of critically ill patients experience anaemia. [1][2][3][4] A number of evidence have shown that anaemia has a deleterious impact on the outcome in patients undergoing surgery. [5][6][7] Baron et al conducted a multicentre study with 39,309 patients undergoing in-patient surgery in 28 European nations and implicated anaemia with poor postsurgery outcomes, including hospital length of stay, postoperative admission to intensive care, and in-hospital mortality [5].…”

Patient Blood Management in intensive care patients

“…Overall, longer ICU treatment is positively correlated with the development of severe anaemia [10]. In addition, anaemia often persists in the first year after hospital discharge [4 ▪ ] and is an independent risk factor for morbidity and mortality [3,7 ▪▪ ,11 ▪ ,12–14]…”