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Lower hemoglobin concentration decreases time to death in severely anemic patients for whom blood transfusion is not an option
- Source :
- Journal of Trauma and Acute Care Surgery. 88:803-808
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- BACKGROUND Anemia in patients who decline transfusion has been associated with increased morbidity and mortality. We hypothesized that the time to death decreases with increasing severity of anemia in patients for whom transfusion is not an option. METHODS With institutional review board approval, a retrospective review of registered adult blood refusal patients with at least one hemoglobin (Hb) value of 12.0 g/dL or less during hospital admission at a single institution from January 2004 to September 2015 was performed. The association of nadir Hb category and time to death (all-cause 30-day mortality) was determined using Kaplan-Meier plots, log rank tests, and Cox proportional hazard models. We investigated if there was a nadir Hb level between the values of 5.0 and 6.0 g/dL at which mortality risk significantly increased and then categorized nadir Hb by the traditional cut points and the newly identified "critical" cut point. RESULTS The study population included 1,011 patients. The Cox proportional hazard models showed a more than 50% increase in hazard of death per 1 g/dL decrease in Hb (adjusted hazard ratio [confidence interval], 1.55 [1.40-1.72]; p < 0.001). A Hb value of 5.0 g/dL was identified as defining "critical anemia." We found a strong association between anemia severity level and mortality (p < 0.001). Time to death was shorter (median, 2 days) in patients with critical anemia than in those having higher Hb (median time to death of 4 or 6 days, in severe or moderate anemia). CONCLUSION In anemic patients unable to be transfused, critical anemia was associated with a significantly and clinically important reduced time to death. LEVEL OF EVIDENCE Prognostic, level III.
- Subjects :
- medicine.medical_specialty
Blood transfusion
Anemia
business.industry
Proportional hazards model
medicine.medical_treatment
Hazard ratio
030208 emergency & critical care medicine
Critical Care and Intensive Care Medicine
medicine.disease
Gastroenterology
Confidence interval
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Population study
Surgery
Hemoglobin
business
Survival analysis
Subjects
Details
- ISSN :
- 21630763 and 21630755
- Volume :
- 88
- Database :
- OpenAIRE
- Journal :
- Journal of Trauma and Acute Care Surgery
- Accession number :
- edsair.doi...........9f007a5ab57605051bac3cc26ddbfcc0