Early Post-Hospitalization Hemoglobin Recovery and Clinical Outcomes in Survivors of Critical Illness: A Population-Based Cohort Study

Abstract

Anemia is common during critical illness, is associated with adverse clinical outcomes, and often persists after hospitalization. The goal of this investigation is to assess the relationships between post-hospitalization hemoglobin recovery and clinical outcomes after survival of critical illness. This is a population-based observational study of adults (≥18 years) surviving hospitalization for critical illness between January 1, 2010 and December 31, 2016 in Olmsted County, Minnesota, United States with hemoglobin concentrations and clinical outcomes assessed through one-year post-hospitalization. Multi-state proportional hazards models were utilized to assess the relationships between 1-month post-hospitalization hemoglobin recovery and hospital readmission or death through one-year after discharge. Among 6460 patients that survived hospitalization for critical illness during the study period, 2736 (42%) were alive, not hospitalized, and had available hemoglobin concentrations assessed at 1-month post-index hospitalization. Median (interquartile range) age was 69 (56, 80) years with 54% of male gender. Overall, 86% of patients had anemia at the time of hospital discharge, with median discharge hemoglobin concentrations of 10.2 (9.1, 11.6) g/dL. In adjusted analyses, each 1 g/dL increase in 1-month hemoglobin recovery was associated with decreased instantaneous hazard for hospital readmission (HR 0.87 [95% CI 0.84-0.90]; p < 0.001) and lower mortality (HR 0.82 [95% CI 0.75-0.89]; p < 0.001) through one-year post-hospitalization. The results were consistent in multiple pre-defined sensitivity analyses. Impaired early post-hospitalization hemoglobin recovery is associated with inferior clinical outcomes in the first year of survival after critical illness. Additional investigations are warranted to evaluate these relationships.

The Association of Postoperative Anaemia with Outcomes in Cardiac Surgical Patients Eligible for Patient Blood Management: A Single Institution Retrospective Cohort Study

“…36, 38 Among patients within one year of hospitalization for surgery and critical illness, each monthly 10 g/L recovery in haemoglobin is associated with a lower instantaneous hazard for readmission (adjusted hazard ratio 0.87; 95% CI 0.84-0.90; p < 0.001) and mortality (adjusted hazard ratio 0.82; 95% CI 0.75-0.89; p < 0.001). 39 Concurrently, and as this study demonstrates, this risk appears heightened in patients with preoperative anaemia which remains untreated.…”

Practical Anemia Bundle for Sustained Blood Recovery (PABST-BR) in critical illness: a protocol for a randomised controlled trial

“…Open access that survivors with improved early post-hospitalisation haemoglobin recovery are less likely to be rehospitalised or die in the subsequent year. 5 Numerous clinical trials in critically ill patients have evaluated treatment of anaemia with iron and/or erythropoietin (EPO). [6][7][8][9][10][11] While these therapies have consistently augmented haemoglobin recovery, they have had inconsistent results on transfusion reductions and mortality and have not been widely adopted into clinical practice.…”

“… 2 Additional evidence suggests that survivors with improved early post-hospitalisation haemoglobin recovery are less likely to be rehospitalised or die in the subsequent year. 5 …”

“…Recent data from survivors of critical illness suggests that anaemia during critical illness is associated with impaired physical function 3 months later 2. Additional evidence suggests that survivors with improved early post-hospitalisation haemoglobin recovery are less likely to be rehospitalised or die in the subsequent year 5…”

“…While these therapies have consistently augmented haemoglobin recovery, they have had inconsistent results on transfusion reductions and mortality and have not been widely adopted into clinical practice. However, there is increasing recognition that anaemia may contribute to persistent functional impairments after survival of hospitalisation 1 2 5. As such, strategies to augment haemoglobin recovery may favourably influence post-hospitalisation outcomes.…”