On-admission anemia predicts mortality in COVID-19 patients: A single center, retrospective cohort study

Abstract

Objectives We investigated the impact of anemia based on admission hemoglobin (Hb) level as a prognostic risk factor for severe outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods A single-center, retrospective cohort study was conducted from a random sample of 733 adult patients (age ≥ 18 years) obtained from a total of 4356 laboratory confirmed SARS-CoV-2 cases who presented to the Emergency Department of Montefiore Medical Center between March–June 2020. The primary outcome was a composite endpoint of in-hospital severe outcomes of COVID-19. A secondary outcome was in-hospital all-cause mortality. Results Among the 733 patients included in our final analysis, 438 patients (59.8%) presented with anemia. 105 patients (14.3%) had mild, and 333 patients (45.5%) had moderate-severe anemia. Overall, 437 patients (59.6%) had a composite endpoint of severe outcomes. On-admission anemia was an independent risk factor for all-cause mortality, (Odds Ratio 1.52, 95% CI [1.01–2.30], p = 0.046) but not for composite severe outcomes. However, moderate-severe anemia (Hb < 11 g/dL) on admission was independently associated with both severe outcomes (OR1.53, 95% CI [1.05–2.23], p = 0.028) and mortality (OR 1.67, 95% CI [1.09–2.56], p = 0.019) during hospitalization. Conclusion Anemia on admission was independently associated with increased odds of all-cause mortality in patients hospitalized with COVID-19. Furthermore, moderate-severe anemia (Hb <11 g/dL) was an independent risk factor for severe COVID-19 outcomes. Moving forward, COVID-19 patient management and risk stratification may benefit from addressing anemia on admission.

Prognostic factors associated with COVID-19 related severity in sickle cell disease

“…In regard to risk factors for COVID-19 related severity, the only variable that held up to MVA for the outcome of hospitalization was admission Hb; this is consistent with previous findings of a significant Hb decrease from baseline for SCD patients requiring hospitalization [1] and studies that reported Hb as a strong predictor of COVID-19 related severity or mortality in the general population [16] , [24] , [25] For the outcome of ICU admission, 3 variables remained significant in the MVA: HCW employment, HU use, and immature granulocyte count on admission. HCW employment has not been previously reported as a risk factor in SCD ICU admission but has been associated with COVID-19 morbidity in the general US population as well as comprehensive meta-analysis [13] , [14] .. HU use has been reported to reduce morbidity in SCD in one report [1] but not others [10] , [21] .…”

Anemia during SARS-CoV-2 infection is associated with rehospitalization after viral clearance

“…(C) A defined set of anemia and kidney-related laboratory test measurements were compared between the PCH and PCNH cohorts in the pre-COVID and SARS-CoV-2 + intervals. iScience Article been suggested as biomarkers for mortality and disease severity in patients with COVID-19 (Chan et al, 2021;Faghih Dinevari et al, 2021;Hariyanto and Kurniawan, 2020;Nadim et al, 2020;Oh et al, 2021). However, our previously mentioned NLP analysis was the first to associate anemia with the long COVID syndrome and rehospitalization after SARS-CoV-2 clearance.…”

Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain

“…For example, the levels of albumin, hemoglobin, the mean platelet volume, and inflammatory markers (monocyte to eosinophil or neutrophil to lymphocyte ratios) are prognostic markers in patients with COVID-19 ( 17 – 19 ). In particular, anemia has been shown to be an independent predictor of mortality in COVID-19 patients ( 20 – 22 ). Therefore, we hypothesized that the inclusion of inflammatory and hematological markers would modulate the associations of obesity and hyperglycemia with death and ICU admission.…”