Anemia and 90-day mortality in COPD patients requiring invasive mechanical ventilation

Rasmussen, Lone Banke; Christensen, Steffen; Lenler-Petersen, P; Johnsen, Søren P

doi:10.2147/clep.s12885

Cited by 36 publications

(20 citation statements)

References 24 publications

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“…Cote et al22 demonstrated that anemic COPD patients had significantly shorter median survival (49 versus 74 months) compared with nonanemics. In a study of patients requiring IMV, the overall 90-day mortality among anemic COPD patients was 57.1% versus 25% for nonanemics 23. The mechanism of anemia in COPD and its impact on survival are unclear, but it has been suggested that the prognostic importance of COPD-related anemia may be its association with systemic inflammation in severe disease 24.…”

Section: Discussionmentioning

confidence: 99%

Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Mydin¹,

Murphy²,

Clague³

et al. 2013

COPD

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BackgroundIn patients with acute hypercapnic respiratory failure (AHRF) during exacerbations of COPD, mortality can be high despite noninvasive ventilation (NIV). For some, AHRF is terminal and NIV is inappropriate. However there is no definitive method of identifying patients who are unlikely to survive. The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD.MethodsCOPD patients presenting with AHRF and who were treated with NIV were studied prospectively. The forced expiratory volume in 1 second (FEV1), World Health Organization performance status (WHO-PS), clinical observations, a composite physiological score (Early Warning Score), routine hematology and biochemistry, and arterial blood gases prior to commencing NIV, were recorded.ResultsIn total, 65 patients were included for study, 29 males and 36 females, with a mean age of 71 ± 10.5 years. Inpatient mortality in the group was 33.8%. Mortality at 30 days and 12 months after admission were 38.5% and 58.5%, respectively. On univariate analysis, the variables associated with inpatient death were: WHO-PS ≥ 3, long-term oxygen therapy, anemia, diastolic blood pressure < 70 mmHg, Early Warning Score ≥ 3, severe acidosis (pH < 7.20), and serum albumin < 35 g/L. On multivariate analysis, only anemia and WHO-PS ≥ 3 were significant. The presence of both predicted 68% of inpatient deaths, with a specificity of 98%.ConclusionWHO-PS ≥ 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD. A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV.

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Section: Discussionmentioning

confidence: 99%

Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Mydin¹,

Murphy²,

Clague³

et al. 2013

COPD

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“…Investigation of potential BC biomarkers is an emerging technology for risk assessment and early diagnosis of BC. Recently, different studies have been performed to investigate potential biomarkers of caner [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], including the investigations on breast milk [25][26][27][28][29][30]. As reviewed previously, a non-invasive tool for early detection of BC could be particularly beneficial for women of reproductive age, as current imaging tools are less effective in detecting cancer in the relatively dense breasts of younger women, and because the incidence of pregnancy associated BC is predicted to increase as the age of first pregnancy increase.…”

Section: Introductionmentioning

confidence: 99%

Comparative two‐dimensional polyacrylamide gel electrophoresis (2D‐PAGE) of human milk to identify dysregulated proteins in breast cancer

et al. 2018

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Breast cancer (BC) remains a major cause of mortality, and early detection is considered important for reducing BC-associated deaths. Early detection of BC is challenging in young women, due to the limitations of mammography on the dense breast tissue of young women. We recently reported results of a pilot proteomics study, using one-dimensional polyacrylamide gel electrophoresis (1D-PAGE) and mass spectrometry (MS) to investigate differences in milk proteins from women with and without BC. Here, we applied two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and MS to compare the protein pattern in milk from the breasts of a single woman who was diagnosed with BC in one breast 24 months after donating her milk. Statistically different gel spots were picked for protein digestion followed by nanoliquid chromatography tandem MS (nanoLC-MS/MS) analysis. The upregulated proteins in BC versus control are alpha-amylase, gelsolin isoform a precursor, alpha-2-glycoprotein 1 zinc isoform CRA_b partial, apoptosis-inducing factor 2 and vitronectin. Several proteins were downregulated in the milk of the breast later diagnosed with cancer as compared to the milk from the healthy breast, including different isoforms of albumin, cholesterol esterase, different isoforms of lactoferrin, different proteins from the casein family and different isoforms of lysozyme. Results warrant further studies to determine the usefulness of these milk proteins for assessing risk and detecting occult disease. MS data is available via ProteomeXchange with identifier PXD009860.

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“…While prior work that has shown that anemia in critical illness is associated with worse outcomes (8) (9) (10), more recent observational and randomized controlled trials (RCTs) have shown that transfusions are associated with worse clinical outcomes as well (24) (26) (27) (28) (29), and that a restrictive transfusion strategy does not portend worse outcomes (17) (11). Thus, while anemia is not desirable, red blood cell transfusions can be harmful too and should not be advocated for all patients who are anemic.…”

Section: Discussionmentioning

confidence: 99%

“…The physiological consequences of anemia can be seen in both healthy and diseased individuals, and anemia has been associated with poor outcomes in the critically ill including failure to wean from mechanical ventilation, myocardial infarction, and increased mortality (8) (9) (10) (11). …”

Section: Introductionmentioning

confidence: 99%

Daily Lowest Hemoglobin and Risk of Organ Dysfunctions in Critically Ill Patients

Hemauer

Kingeter

Han

et al. 2017

Critical Care Medicine

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Objective To determine the association between hemoglobin levels and the daily risk of individual organ dysfunctions in critically ill patients. Design We performed a post-hoc analysis of prospectively collected data in medical and surgical ICU patients admitted with respiratory failure or shock. Baseline demographic data, and detailed in-ICU and hospital data, including daily lowest hemoglobin, were collected up to hospital day 30. We assessed patients daily for brain dysfunction [delirium, using Confusion Assessment Method for ICU (CAM-ICU)], for renal and respiratory dysfunction [using the ordinal renal and respiratory Sequential Organ Failure Assessment (SOFA score)], and for ICU mortality. Associations between the lowest hemoglobin on a given day and organ dysfunctions the following day were assessed using multivariable regressions, adjusting for age, APACHE II score, Charlson comorbidity index, Framingham stroke risk profile, ICU day, ICU type, sepsis, and current organ dysfunction status. A sensitivity analysis further adjusted for daily transfusions and fluid balance in a subset of our patients. Measurements and Main Results We enrolled 821 patients with a median (interquartile range, IQR) age of 61 (51, 71) years, APACHE II score of 25 (19, 31), and hemoglobin level of 10.0 (9.0, 11.1) g/dl. There was no evidence of an association between lowest daily hemoglobin and brain dysfunction (p=0.69 for delirium), renal dysfunction (p=0.30) or ICU mortality (p=0.95). The lowest hemoglobin on a given day was significantly associated with the respiratory SOFA score the following day; for each increasing hemoglobin unit, the odds of worsened respiratory SOFA score the following day were decreased by 36% (OR 0.64, 95% CI: 0.53, 0.77, p < 0.001). The sensitivity analysis including daily transfusions and fluid balance (in a subset of 518 patients) did not qualitatively change any of these associations. Conclusions In this study in ICU patients, lower hemoglobin was associated with a higher probability of worsening respiratory dysfunction scores the following day. There was no evidence of association between hemoglobin and brain or renal dysfunction, or ICU mortality. The possible differential effects of anemia on organ dysfunctions seen in this hypothesis generating study will have to be studied in a larger prospective study before any alterations to present restrictive transfusion guidelines can be recommended.

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Anemia and 90-day mortality in COPD patients requiring invasive mechanical ventilation

Cited by 36 publications

References 24 publications

Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Comparative two‐dimensional polyacrylamide gel electrophoresis (2D‐PAGE) of human milk to identify dysregulated proteins in breast cancer

Daily Lowest Hemoglobin and Risk of Organ Dysfunctions in Critically Ill Patients

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