On-Admission Anemia and Survival Rate in COVID-19 Patients

Asadzadeh, Reza; Mozafari, Aliashraf; Shafiei, Elham; Kaffashian, Mohammad Reza; Ahmadi, Iraj; Darvish, Mohammadzaman; Bastaminejad, Saiyad

doi:10.52547/ibj.3703

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…Interestingly, the prevalence of anemia at admission was similar to the one for community-acquired in both adults 12 and children 27 hospitalised for non-COVID community-acquired pneumonia, thus suggesting that this finding may be a characteristic shared also with other lower-respiratory tract infections. Likewise, the association between baseline presence of anemia and the poor clinical outcomes reported here is consistent with other studies involving patients with both COVID-19 28 , 29 and non-COVID related pneumonia 12 , 27 .…”

Section: Discussionsupporting

confidence: 91%

Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study

Veronese

Segala

Carruba

et al. 2023

Sci Rep

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In respiratory infections, anemia is both a consequence of acute inflammation and a predictor of poor clinical outcomes. There are few studies investigating the role of anemia in COVID-19, suggesting a potential role in predicting disease severity. In this study, we aimed to assess the association between the presence of anemia at admission and incidence of severe disease and death in patients hospitalized for COVID-19. Data from all adult patients admitted for COVID-19 in University Hospital “P. Giaccone” Palermo, and University Hospital of Bari, Italy, were retrospectively collected from 1st of September 2020 to 31 August 2022. The association between anemia (defined as Hb < 13 g/dl and < 12 g/dl in males and females, respectively), in-hospital mortality and severe COVID-19 was tested using a Cox’s regression analysis. Severe COVID-19 forms were defined as admission to intensive or sub-intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. p values were calculated using the Student’s t test for continuous variables and the Mantel–Haenszel Chi-square test for categorical ones. The association between anemia and the mortality was made using a Cox’s regression analysis, adjusted, in two models, for the potential confounders and using a propensity score. Among the 1562 patients included in the analysis, prevalence of anemia was 45.1% (95% CI 43–48%). Patients with anemia were significantly older (p < 0.0001), reported more co-morbidities, and presented higher baseline levels of procalcitonin, CRP, ferritin and IL-6. Overall, the crude incidence of mortality was about four times higher in patients with anemia compared to those without. After adjusting for 17 potential confounders, the presence of anemia significantly increased the risk of death (HR = 2.68; 95% CI: 1.59–4.52) and of risk of severe COVID-19 (OR = 2.31; 95% CI: 1.65–3.24). The propensity score analysis substantially confirmed these analyses. Our study provides evidence that, in patients hospitalized for COVID-19, anemia is both associated with a more pronounced baseline pro-inflammatory profile and higher incidence of in-hospital mortality and severe disease.

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Section: Discussionsupporting

confidence: 91%

Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study

Veronese

Segala

Carruba

et al. 2023

Sci Rep

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“…A systematic review of 63 studies showed that severe SARS-CoV-2 infection is associated with lower Hb levels [35], and a study by Fan et al showed that 1.6% of SARS-CoV-2 patients admitted to the intensive care unit received blood transfusions for anemia correction [36]. Most studies, including ours, have shown that anemia is an independent predictor of mortality and that each unit of increase in Hb in COVID-19 patients enhanced the survival rate by 4% [30,37,38]. A meta-analysis based on risk factor-adjusted effect estimates indicated that anemia was independently associated with a significantly elevated risk for mortality among COVID-19 patients [39], while another study documented that in COVID-19 patients, anemia is both associated with a more pronounced baseline pro-inflammatory profile and a higher incidence of in-hospital mortality and severe disease [40].…”

Section: Discussionmentioning

confidence: 66%

COVID-19: The Development and Validation of a New Mortality Risk Score

Zinna,

Pipitò,

Colomba

et al. 2024

JCM

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Background: The coronavirus disease 2019 (COVID-19) pandemic has found the whole world unprepared for its correct management. Italy was the first European country to experience the spread of the SARS-CoV-2 virus at the end of February 2020. As a result of hospital overcrowding, the quality of care delivered was not always optimal. A substantial number of patients admitted to non-ICU units could have been treated at home. It would have been extremely useful to have a score that, based on personal and clinical characteristics and simple blood tests, could have predicted with sufficient reliability the probability that a patient had or did not have a disease that could have led to their death. This study aims to develop a scoring system to identify which patients with COVID-19 are at high mortality risk upon hospital admission, to expedite and enhance clinical decision making. Methods: A retrospective analysis was performed to develop a multivariable prognostic prediction model. Results: Derivation and external validation cohorts were obtained from two Italian University Hospital databases, including 388 (10.31% deceased) and 1357 (7.68% deceased) patients with confirmed COVID-19, respectively. A multivariable logistic model was used to select seven variables associated with in-hospital death (age, baseline oxygen saturation, hemoglobin value, white blood cell count, percentage of neutrophils, platelet count, and creatinine value). Calibration and discrimination were satisfactory with a cumulative AUC for prediction mortality of 0.924 (95% CI: 0.893–0.944) in derivation cohorts and 0.808 (95% CI: 0.886–0.828) in external validation cohorts. The risk score obtained was compared with the ISARIC 4C Mortality Score, and with all the other most important scores considered so far, to evaluate the risk of death of patients with COVID-19. It performed better than all the above scores to evaluate the predictability of dying. Its sensitivity, specificity, and AUC were higher than the other COVID-19 scoring systems when the latter were calculated for the 388 patients in our derivation cohort. Conclusions: In conclusion, the CZ-COVID-19 Score may help all physicians by identifying those COVID-19 patients who require more attention to provide better therapeutic regimens or, on the contrary, by identifying those patients for whom hospitalization is not necessary and who could therefore be sent home without overcrowding healthcare facilities. We developed and validated a new risk score based on seven variables for upon-hospital admission of COVID-19 patients. It is very simple to calculate and performs better than all the other similar scores to evaluate the predictability of dying.

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“…Recent research has demonstrated a link between anemia and severe COVID-19 disease presentation. However, these studies were primarily conducted with adult cohorts or even excluded pediatric populations entirely [ 14 , 15 , 16 ]. However, although it has been shown that children tend to experience a milder course of the disease when compared with adult populations [ 6 ], this case highlights that severe COVID-19 may also occur in pediatric populations.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that iron and B12 deficiencies result in low levels of hemoglobin and red blood cells, leading to a decrease in their oxygen-carrying capacity [ 21 ]. In patients with severe COVID-19 pneumonia, such as the one presented in this case study, this decreased oxygen-carrying capacity is detrimental to patient survival, especially in light of the hyper-metabolic state caused by the infection [ 14 , 15 ]. Moreover, it has been suggested in the literature that SARS-CoV-2 can lower functional hemoglobin levels and interfere with iron transport and red blood cell production, further decreasing oxygen-carrying capacity and exacerbating anemia [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Severe COVID-19 Pneumonia in a Three-Year-Old with Congenital Iron and B12 Deficiency Anemia of Unknown Etiology: A Case Report

2023

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Since COVID-19 first emerged in Wuhan, China, and was declared a global pandemic by the WHO, researchers have been meticulously studying the disease and its complications. Studies of severe COVID-19 disease among pediatric populations are scarce, leading to difficulty in establishing a comprehensive management approach. Case presentation: This report outlines a case of a long-standing combined iron and vitamin B12 deficiency anemia in a three-year-old treated at the Children’s Clinical University Hospital due to severe COVID-19 disease. The patient’s clinical condition coincided with the derangement of biomarkers described in the literature, including lymphopenia, increased neutrophil/lymphocyte ratio (NLR), decreased lymphocyte/C-reactive protein ratio (LCR), as well as elevated inflammatory markers such as CRP and D-dimers. The patient developed severe bilateral pneumonia requiring invasive ventilation, high-flow oxygen, immunosuppressive therapy with dexamethasone and tocilizumab, and supplementation of anemia deficits with blood transfusion and vitamin B12 administration. Conclusions: Our findings are consistent with the most important biomarkers reported in the literature indicative of severe disease progression. Additionally, poorly controlled anemia may be suggested as a potentially important risk factor for severe COVID-19 disease among children. However, additional quantitative research is required to establish the nature and severity of the risk.

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On-Admission Anemia and Survival Rate in COVID-19 Patients

Cited by 7 publications

References 34 publications

Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study

Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study

COVID-19: The Development and Validation of a New Mortality Risk Score

Severe COVID-19 Pneumonia in a Three-Year-Old with Congenital Iron and B12 Deficiency Anemia of Unknown Etiology: A Case Report

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