Effects of Anemia on Clinical Outcomes in Hospitalized Patients with COVID-19 Pneumonia

Hilal Kurtoğlu Gümüşel; Selçuk Görmez; Ömer Özçağlayan; Burak Pamukçu

doi:10.31067/acusaglik.1039533

Research Article

BibTex

RIS

Cite

Effects of Anemia on Clinical Outcomes in Hospitalized Patients with COVID-19 Pneumonia

Year 2022, , 316 - 322, 01.07.2022

Hilal Kurtoğlu Gümüşel , Selçuk Görmez , Ömer Özçağlayan , Burak Pamukçu

https://doi.org/10.31067/acusaglik.1039533

Abstract

Objective: We aimed to examine the role of anemia on clinical outcomes including intensive care unit (ICU) admission and mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients.
Materials and methods: Totally 175 hospitalized COVID-19 patients were retrospectively included. Patients with a hemoglobin level of <12 g/dL in women and <13 g/dL in men constituted the anemic group, while COVID-19 patients with normal hemoglobin levels constituted the non-anemic group. A logistic regression analysis was performed to investigate the role of anemia and serum ferritin value for prediction of ICU and MV requirement.
Results: Of patients, 46 (45.7%, 21 men) had anemia and 129 (68.2%, 88 men) had normal hemoglobin levels. The ICU requirement and MV rates were significantly higher in anemic group compared to non-anemic group (30.4% vs. 15.5%, respectively; p=0.028 and 23.9% vs. 10.9%, respectively; p=0.030). Median length of hospital and ICU stay was longer in patients with anemia (10.5 days vs. 8 days, respectively; p=0.047 and 0 days vs. 0 days, respectively; p=0.027). Anemia and ferritin were significant risk factors for ICU admission in univariate model and multivariate model [OR: 2.384 (95% CI: 1.084-5.246), p=0.031] vs. [OR: 2.738 (95% CI: 1.130-6.635), p=0.026] and [OR: 5.058 (95% CI: 1.968-12.998), p=0.001] vs. [OR: 4.218 (95% CI: 1.521-11.697), p=0.006]. Anemia was also a risk factor for MV [OR: 2.582 (95% CI: 1.075-6.197), p=0.034].
Conclusion: Requirement for therapy in ICU and MV were high among anemic COVID-19 patients. Anemia is also associated with prolonged length of stay in hospital and ICU.

Keywords

Coronavirus disease 2019 (COVID-19), Anemia, Intensive care unit

References

1. Murthy S, Gomersall CD, Fowler RA. Care for critically ill patients with COVID-19. JAMA. 2020; 15: 1499-1500.
2. Wu Z, McGoogan J.M. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323: 1239-42.
3. Bi Q, Wu Y, Mei S, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: A retrospective cohort study. Lancet Infect Dis. 2020 Aug;20(8):911-919. doi: 10.1016/S1473-3099(20)30287-5. Epub 2020 Apr 27. Erratum in: Lancet Infect Dis. 2020 Jul;20(7):e148. PMID: 32353347; PMCID: PMC7185944.
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020; 395(10223): 497–506.
5. L Anesi G. COVID-19: Management of the intubated adult. https://www.uptodate.com/contents/covid-19-management-of-the-intubated-adult. Access date 10 August 2021
6. Mokhtari T, Hassani F, Ghaffari N, et al. COVID-19 and multiorgan failure: A narrative review on potential mechanisms. J Mol Histol. 2020; 51(6): 613-628.
7. Cassat James E, Skaar Eric P. Iron in Infection and Immunity. Cell Host & Microbe. 2013; 13(5): 509-19.
8. WHO/UNICEF/UNU. Iron deficiency anaemia: assessment, prevention, and control. Geneva, World Health Organization, 2001 (WHO/NHD/01.3). (http://www.who.int/nut/documents/ida_assessment_ prevention_control.pdf, access date 27 July 2004.
9. Hayden SJ, Albert TJ, Watkins TR, et al. Anemia in critical illness: insights into etiology, consequences, and management. Am J Respir Crit Care Med. 2012; 185(10): 1049–1057.
10. Chambellan A, Chailleux E, Similowski T; ANTADIR Observatory Group. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy. Chest. 2005 Sep;128(3):1201-8. doi: 10.1378/chest.128.3.1201. Erratum in: Chest. 2006 Mar;129(3):831. PMID: 16162707.
11. Groenveld HF, Januzzi JL, Damman K. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol. 2008; 52(10): 818–827.
12. Salisbury AC, Alexander KP, Reid KJ. Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010; 3(4):337–346.
13. Reade MC, Weissfeld L, Angus DC, Kellum JA, et al. The prevalence of anemia and its association with 90-day mortality in hospitalized community-acquired pneumonia. BMC Pulm Med. 2010 Mar 16; 10: 15. doi: 10.1186/1471-2466-10-15. PMID: 20233445; PMCID: PMC2848211.
14. Laurent Peyrin-Biroulet, Nicolas Williet, Patrice Cacoub. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. Am J Clin Nutr. 2015; 102(6):1585-94.
15. Adams PC, Barton JC A. Diagnostic approach to hyperferritinemia with a non-elevated transferrin saturation. J Hepatol 2011; 55(2): 453–8.
16. Lerkvaleekul B, Vilaiyuk S. Macrophage activation syndrome: early diagnosis is key. Open Access Rheumatol 2018; 10: 117.
17. Liu X, Zhang R, He G. Hematological findings in coronavirus disease 2019: indications of progression of disease. Ann Hematol 2020; 99 (7): 1421-28.
18. Fan BE, Chong VCL, Chan SSW et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol 2020 Jun;95(6):E131-E134. doi: 10.1002/ajh.25774. Epub 2020 Mar 19. Erratum in: Am J Hematol. 2020 Nov;95(11):1442. PMID: 32129508.
19. Tao Z, Xu J, Chen W. Anaemia is associated with severe illness in COVID-19: a retrospective cohort study. J Med Virol 2021; 93(3): 1478-88.
20. Oh SM, Skendelas JP, Macdonald E et al. On-admission anemia predicts mortality in COVID-19 patients: A single center, retrospective cohort study. Am J Emerg Med 2021; 48: 140-7.
21. Cavezzi A, Troiani E, Corrao S. COVID-19: hemoglobin, iron, and hypoxia beyond inflammation. A narrative review. Clin Pract. 2020; 10(2): 1271.
22. Ehsani S. COVID-19 and iron dysregulation: distant sequence similarity between hepcidin and the novel coronavirus spike glycoprotein. Biol Direct. 2020; 15(1): 19.
23. Atanasiu V, Manolescu B, Stoian I. Hepcidin--central regulator of iron metabolism. Eur J Haematol 2007; 78(1): 1-10.
24. Hemauer SJ, Kingeter AJ, Han X, et al. Daily lowest hemoglobin and risk of organ dysfunctions in critically ill patients. Crit Care Med. 2017; 45(5): e479–e484.
25. Cheng L, Li H, Li L, et al. Ferritin in the coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Lab Anal. 2020; 34:e23618. Doi: 10.1002/jcla23618.
26. Grasselli G, Greco M, Zanella A, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med 2020; 180(10): 1345-55.
27. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020, published online 13 March (doi:10.1001/jamainternmed.2020.0994).
28. Fang X, Li S, Yu H, et al. Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. Aging (Albany NY) 2020; 12(13): 12493-503.
29. Ji W, Huh K, Kang M, et al. Effect of underlying comorbidities on the infection and severity of COVID-19 in Korea: a nationwide case control study. J Korean Med Sci 2020; 35(25): e237.
30. Jin J-M, Bai P, He W, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Public Health, 2020; 8: 152.
31. Suleyman G , Fadel RA , Malette KM , et al. Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Netw Open. 2020; 3(6): e2012270.