Relations of Anemia With the All-Cause Mortality and Cardiovascular Mortality in General Population: A Meta-Analysis

Liu, Zhou; Sun, Rong; Li, Jianting; Cheng, Wenke; Li, Lin

doi:10.1016/j.amjms.2019.05.016

Cited by 34 publications

(32 citation statements)

References 22 publications

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“…In a report of 5700 patients hospitalized for COVID-19 in the New York City area, ferritin levels were pathologically high, a finding in line with previous studies from China (8,9). Both anemia and hyperferritenemia, regardless of the underlying pathology, are strong predictors of mortality (10,11). Anemia could be the result of iron-restricted erythropoiesis arising from alterations in iron metabolism.…”

Section: Introductionsupporting

confidence: 71%

“…Studies have reported that anemia is associated with 2.6 times increased risk of mortality in chronic obstructive pulmonary diseases; the overall 90-day mortality among these patients with acute respiratory failure treated with invasive mechanical ventilation was 57.1% versus 25% in non-anemic patients(22, 23). A previous meta-analysis has shown that among a mixed population, independent of sex, age and cardiovascular diseases, anemia is associated with a 41% and 33% increased risk of all-cause mortality and cardiovascular mortality, respectively (11). A similar risk of mortality was also shown in two other meta-analyses comparing heart failure patients with and without anemia, or stroke patients with and without anemia(24, 25).…”

Section: Discussionmentioning

confidence: 99%

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Anemia and iron metabolism in COVID-19: A systematic review and meta-analysis

Taneri

Gómez‐Ochoa

Llanaj

et al. 2020

Preprint

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Iron metabolism and anemia may play an important role in multiple organ dysfunction syndrome in Coronavirus disease 2019 (COVID-19). If confirmed, this has important implications for the more than 1.62 billion people estimated to have anemia globally. We conducted a systematic review and meta-analysis to evaluate biomarkers of anemia and iron metabolism (hemoglobin, ferritin, transferrin, soluble transferrin receptor, hepcidin, haptoglobin, unsaturated iron-binding capacity, erythropoietin, free erythrocyte protoporphyrine, and prevalence of anemia) in patients diagnosed with COVID-19, and explore their prognostic value. Six bibliographic databases were searched up to May 5th 2020. We included 56 unique studies, with data from 14,044 COVID-19 patients (59 years median age). Pooled mean hemoglobin and ferritin levels in COVID-19 patients across all ages were 130.41 g/L (95% Confidence Interval (CI), 128.42; 132.39) and 673.91 ng/mL (95% CI, 420.98; 926.84), respectively. Hemoglobin levels decreased with advancing age and increasing percentage of comorbid and critically ill patients, while levels of ferritin increased with increasing male proportion and mean hemoglobin levels. Compared to moderate cases, severe cases had lower pooled mean hemoglobin [weighted mean difference (WMD), -4.21 (95% CI -6.63; -1.78)] and higher ferritin [WMD, -730.55 ng/mL (95% CI 413.24; 1047.85)]. A significant difference in mean ferritin level of 1027.23 ng/mL (95% CI 819.53; 1234.94) was found between survivors and non-survivors, but not in hemoglobin levels. No studies provided information on anemia or other biomarkers of interest. Future studies should explore the impact of iron metabolism and anemia and in the pathophysiology, prognosis, and treatment of COVID-19.

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Section: Introductionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Anemia and iron metabolism in COVID-19: A systematic review and meta-analysis

Taneri

Gómez‐Ochoa

Llanaj

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Studies have reported that anemia is associated with 2.6 times increased risk of mortality in chronic obstructive pulmonary diseases; the overall 90-day mortality among these patients with acute respiratory failure treated with invasive mechanical ventilation was 57.1% versus 25% in non-anemic patients [ 31 , 32 ]. A previous meta-analysis has shown that among a mixed population, independent of sex, age and cardiovascular diseases, anemia is associated with a 41% and 33% increased risk of all-cause mortality and cardiovascular mortality, respectively [ 11 ]. A similar risk of mortality was also shown in two other meta-analyses comparing heart failure patients with and without anemia, or stroke patients with and without anemia [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a report of 5700 patients hospitalized for COVID-19 in the New York City area, ferritin levels were pathologically high, a finding in line with previous studies from China [ 8 , 9 ]. Both anemia and hyperferritinemia, regardless of the underlying pathology, are strong predictors of mortality [ 10 , 11 ]. Anemia could be the result of iron-restricted erythropoiesis arising from alterations in iron metabolism.…”

Section: Introductionmentioning

confidence: 99%

Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Iron metabolism and anemia may play an important role in multiple organ dysfunction syndrome in Coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to evaluate biomarkers of anemia and iron metabolism (hemoglobin, ferritin, transferrin, soluble transferrin receptor, hepcidin, haptoglobin, unsaturated iron-binding capacity, erythropoietin, free erythrocyte protoporphyrine, and erythrocyte indices) in patients diagnosed with COVID-19, and explored their prognostic value. Six bibliographic databases were searched up to August 3rd 2020. We included 189 unique studies, with data from 57,563 COVID-19 patients. Pooled mean hemoglobin and ferritin levels in COVID-19 patients across all ages were 129.7 g/L (95% Confidence Interval (CI), 128.51; 130.88) and 777.33 ng/mL (95% CI, 701.33; 852.77), respectively. Hemoglobin levels were lower with older age, higher percentage of subjects with diabetes, hypertension and overall comorbidities, and admitted to intensive care. Ferritin level increased with older age, increasing proportion of hypertensive study participants, and increasing proportion of mortality. Compared to moderate cases, severe COVID-19 cases had lower hemoglobin [weighted mean difference (WMD), − 4.08 g/L (95% CI − 5.12; − 3.05)] and red blood cell count [WMD, − 0.16 × 1012 /L (95% CI − 0.31; − 0.014)], and higher ferritin [WMD, − 473.25 ng/mL (95% CI 382.52; 563.98)] and red cell distribution width [WMD, 1.82% (95% CI 0.10; 3.55)]. A significant difference in mean ferritin levels of 606.37 ng/mL (95% CI 461.86; 750.88) was found between survivors and non-survivors, but not in hemoglobin levels. Future studies should explore the impact of iron metabolism and anemia in the pathophysiology, prognosis, and treatment of COVID-19.

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“…Lower Hb and higher ferritin levels were observed in patients with COVID‐19 infection indicating the possible impact of altered iron metabolism in the pathogenesis of this novel disease. Increased ferritin levels were found to be associated with poor prognosis in various studies 37,38 . Iron is an essential micronutrient for pathogens and for this reason the host's immune system generally restricts the availability of iron during infections as a defensive mechanism leading to increased ferritin levels 36 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of maternal serum afamin and vitamin E levels in pregnant women with COVID‐19 and its association with composite adverse perinatal outcomes

Erol

Tanaçan

Anuk

et al. 2020

Journal of Medical Virology

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To evaluate the maternal serum afamin and vitamin E levels in pregnant women with coronavirus disease 2019 (COVID‐19) and to investigate their association with composite adverse perinatal outcomes. This prospective, case‐control study consisted of 60 pregnant women with COVID‐19 infection and 36 age‐matched pregnant women without any defined risk factors. Demographic features, laboratory test results, afamin and vitamin E levels were compared between the groups. A receiver operating characteristic (ROC) curve was used to assess the relationship of afamin and vitamin E levels in predicting composite adverse perinatal outcomes. A correlation analysis was performed between afamin and C‐reactive protein (CRP) levels in pregnant women with COVID‐19. The obstetric complication rate was higher in the COVID‐19 group (13.3% vs. 2.8%) (p = .01). Afamin levels were higher and vitamin E levels were lower in the COVID‐19 group (p = .02 and p < .001, respectively). Vitamin E levels were lower in the COVID‐19 group for the all trimesters (p < .001, p < .001, and p = .004, respectively). Afamin levels were higher in the COVID‐19 group for the all trimesters without reaching statistical significance (p > .05). The values in the ROC curves with the best balance of sensitivity/specificity for afamin and vitamin E were 0.424 mg/l (70.6% sensitivity, 44.3% specificity) and 3.150 µg/ml (76.5% sensitivity, 58.2% specificity), respectively. A positive moderate statistically significant correlation was found between afamin and CRP levels (r = .264, p = .009). Higher afamin and lower vitamin E levels may support the elevated oxidative stress in the etiopathogenesis of COVID‐19 and the relationship with composite adverse perinatal outcomes.

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Relations of Anemia With the All-Cause Mortality and Cardiovascular Mortality in General Population: A Meta-Analysis

Cited by 34 publications

References 22 publications

Anemia and iron metabolism in COVID-19: A systematic review and meta-analysis

Anemia and iron metabolism in COVID-19: A systematic review and meta-analysis

Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis

Evaluation of maternal serum afamin and vitamin E levels in pregnant women with COVID‐19 and its association with composite adverse perinatal outcomes

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