Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

Abstract

Background Anemia and elevated red cell distribution width (RDW) or mean corpuscular volume (MCV) are associated with an adverse prognosis in patients with cardiovascular disease and critical illness. Limited data exist regarding these associations in unselected cardiac intensive care unit (CICU) patients. Methods Retrospective cohort study of CICU patients between January 1, 2007, and December 31, 2015, with a hemoglobin (Hb) level measured at admission. Multivariable regression was performed to determine predictors of hospital mortality, and Kaplan-Meier analysis was used to determine post-discharge survival. Results We included 9644 patients with a mean age of 67.5 ± 15.1 years, including 3604 (37.4%) females. The median (IQR) values of Hb, MCV and RDW were 12.2 g/dL (10.6, 13.7), 90.7 fL (87.3, 94.2) fL, and 14.1% (13.3, 15.8), respectively. Anemia (admission Hb < 12 g/dL) was present in 4434 (46%) patients. A total of 845 (8.8%) patients died in the hospital. Patients with anemia had higher hospital mortality (11.3% vs. 6.6%, unadjusted OR 1.82, 95% CI 1.58-2.10, p < 0.001). After multivariable regression, admission Hb and MCV were not significantly associated with hospital mortality (both p > 0.1), while admission RDW (adjusted OR 1.12 per 1%, 95% CI 1.07-1.18, p < 0.001) was significantly associated with hospital mortality. Hospital survivors with lower Hb, higher MCV, or higher RDW had lower post-discharge survival. Conclusion Elevated RDW on admission was independently associated with higher hospital mortality in CICU patients. These data emphasize the importance of hematologic abnormalities for mortality risk stratification in CICU populations. Hamza A. Rayes and Jacob C. Jentzer contributed equally to this work.

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

“…These patients had higher resource utilization and short-term mortality in the unmatched cohort and higher resource utilization in the propensity-matched cohort, suggesting that PAC use is a marker for greater illness severity. 41,42 As noted in our study, in admissions within the non-PAC cohort, RHC was used in those with greater severity, without any differences in outcomes. Smaller studies have shown the use of a PAC to be associated with improved survival in CS because of any aetiology.…”

“…Demographic characteristics, hospital characteristics, acute organ failure, coronary angiography, percutaneous coronary interventions (PCI), and mechanical circulatory support (MCS) use were identified for all admissions using previously used methodologies from our group. [2][3][4][5]8,9,[28][29][30][31][32][33][34][35] Acute noncardiac organ failure was classified as respiratory (acute respiratory failure, other pulmonary insufficiency, acute respiratory distress syndrome, respiratory arrest, and ventilator management), renal (acute kidney injury), and hepatic (acute hepatic failure, hepatic encephalopathy, hepatic infection, and hepatitis unspecified), hematologic (defibrination syndrome, acquired coagulation factor deficiency, coagulation defect, and thrombocytopenia), and neurologic (anoxic brain injury, acute encephalopathy, coma, altered consciousness, and electroencephalogram). [3][4][5]9,30,32 Similar to prior literature from the HCUP-NIS, we used the procedure day for RHC/PAC placement to time concomitant coronary angiography, PCI, MCS, and invasive mechanical ventilation.…”

Selected hematological biomarkers to predict acute mortality in emergency department patients: Recent Polish hospital statistics

“…Furthermore, comparable reports are found about the RDW and mortality. [25] described, in their investigation on 9644 patients coming to a cardiac intensive care unit for admission, an independent association between RDW and hospital mortality. In addition, the RDW seems to be a prognostic marker for 30day mortality in severe sepsis [26].…”

Selected Hematological Biomarkers to Predict Acute Mortality in Emergency Department Patients. Recent Polish Hospital Statistics

“…Furthermore, comparable reports are found about the RDW and mortality. [25] described, in their investigation on 9644 patients coming to a cardiac intensive care unit for admission, an independent association between RDW and hospital mortality. In addition, the RDW seems to be a prognostic marker for 30-day mortality in severe sepsis [26].…”