Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

Hamza A. Rayes, Saraschandra Vallabhajosyula, Gregory W. Barsness, Nandan S. Anavekar, Ronald S. Go, Mrinal S. Patnaik, Kianoush B. Kashani, Jacob C. Jentzer

Research output: Contribution to journalArticle

Abstract

Background: Anemia and elevated red cell distribution width (RDW) or mean corpuscular volume (MCV) are associated with an adverse prognosis in patients with cardiovascular disease and critical illness. Limited data exist regarding these associations in unselected cardiac intensive care unit (CICU) patients. Methods: Retrospective cohort study of CICU patients between January 1, 2007, and December 31, 2015, with a hemoglobin (Hb) level measured at admission. Multivariable regression was performed to determine predictors of hospital mortality, and Kaplan–Meier analysis was used to determine post-discharge survival. Results: We included 9644 patients with a mean age of 67.5 ± 15.1 years, including 3604 (37.4%) females. The median (IQR) values of Hb, MCV and RDW were 12.2 g/dL (10.6, 13.7), 90.7 fL (87.3, 94.2) fL, and 14.1% (13.3, 15.8), respectively. Anemia (admission Hb < 12 g/dL) was present in 4434 (46%) patients. A total of 845 (8.8%) patients died in the hospital. Patients with anemia had higher hospital mortality (11.3% vs. 6.6%, unadjusted OR 1.82, 95% CI 1.58–2.10, p < 0.001). After multivariable regression, admission Hb and MCV were not significantly associated with hospital mortality (both p > 0.1), while admission RDW (adjusted OR 1.12 per 1%, 95% CI 1.07–1.18, p < 0.001) was significantly associated with hospital mortality. Hospital survivors with lower Hb, higher MCV, or higher RDW had lower post-discharge survival. Conclusion: Elevated RDW on admission was independently associated with higher hospital mortality in CICU patients. These data emphasize the importance of hematologic abnormalities for mortality risk stratification in CICU populations. Graphic abstract: [Figure not available: see fulltext.].

Original languageEnglish (US)
JournalClinical Research in Cardiology
DOIs
StateAccepted/In press - Jan 1 2019

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Erythrocyte Indices
Intensive Care Units
Anemia
Mortality
Hemoglobins
Hospital Mortality
Survival
Critical Illness
Survivors
Cohort Studies
Cardiovascular Diseases
Retrospective Studies

Keywords

  • Anemia
  • Cardiac intensive care unit
  • Coronary care unit
  • Mean corpuscular volume
  • Mortality
  • Red cell distribution width

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association between anemia and hematological indices with mortality among cardiac intensive care unit patients. / Rayes, Hamza A.; Vallabhajosyula, Saraschandra; Barsness, Gregory W.; Anavekar, Nandan S.; Go, Ronald S.; Patnaik, Mrinal S.; Kashani, Kianoush B.; Jentzer, Jacob C.

In: Clinical Research in Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Rayes, Hamza A. ; Vallabhajosyula, Saraschandra ; Barsness, Gregory W. ; Anavekar, Nandan S. ; Go, Ronald S. ; Patnaik, Mrinal S. ; Kashani, Kianoush B. ; Jentzer, Jacob C. / Association between anemia and hematological indices with mortality among cardiac intensive care unit patients. In: Clinical Research in Cardiology. 2019.
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abstract = "Background: Anemia and elevated red cell distribution width (RDW) or mean corpuscular volume (MCV) are associated with an adverse prognosis in patients with cardiovascular disease and critical illness. Limited data exist regarding these associations in unselected cardiac intensive care unit (CICU) patients. Methods: Retrospective cohort study of CICU patients between January 1, 2007, and December 31, 2015, with a hemoglobin (Hb) level measured at admission. Multivariable regression was performed to determine predictors of hospital mortality, and Kaplan–Meier analysis was used to determine post-discharge survival. Results: We included 9644 patients with a mean age of 67.5 ± 15.1 years, including 3604 (37.4{\%}) females. The median (IQR) values of Hb, MCV and RDW were 12.2 g/dL (10.6, 13.7), 90.7 fL (87.3, 94.2) fL, and 14.1{\%} (13.3, 15.8), respectively. Anemia (admission Hb < 12 g/dL) was present in 4434 (46{\%}) patients. A total of 845 (8.8{\%}) patients died in the hospital. Patients with anemia had higher hospital mortality (11.3{\%} vs. 6.6{\%}, unadjusted OR 1.82, 95{\%} CI 1.58–2.10, p < 0.001). After multivariable regression, admission Hb and MCV were not significantly associated with hospital mortality (both p > 0.1), while admission RDW (adjusted OR 1.12 per 1{\%}, 95{\%} CI 1.07–1.18, p < 0.001) was significantly associated with hospital mortality. Hospital survivors with lower Hb, higher MCV, or higher RDW had lower post-discharge survival. Conclusion: Elevated RDW on admission was independently associated with higher hospital mortality in CICU patients. These data emphasize the importance of hematologic abnormalities for mortality risk stratification in CICU populations. Graphic abstract: [Figure not available: see fulltext.].",
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T1 - Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

AU - Rayes, Hamza A.

AU - Vallabhajosyula, Saraschandra

AU - Barsness, Gregory W.

AU - Anavekar, Nandan S.

AU - Go, Ronald S.

AU - Patnaik, Mrinal S.

AU - Kashani, Kianoush B.

AU - Jentzer, Jacob C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Anemia and elevated red cell distribution width (RDW) or mean corpuscular volume (MCV) are associated with an adverse prognosis in patients with cardiovascular disease and critical illness. Limited data exist regarding these associations in unselected cardiac intensive care unit (CICU) patients. Methods: Retrospective cohort study of CICU patients between January 1, 2007, and December 31, 2015, with a hemoglobin (Hb) level measured at admission. Multivariable regression was performed to determine predictors of hospital mortality, and Kaplan–Meier analysis was used to determine post-discharge survival. Results: We included 9644 patients with a mean age of 67.5 ± 15.1 years, including 3604 (37.4%) females. The median (IQR) values of Hb, MCV and RDW were 12.2 g/dL (10.6, 13.7), 90.7 fL (87.3, 94.2) fL, and 14.1% (13.3, 15.8), respectively. Anemia (admission Hb < 12 g/dL) was present in 4434 (46%) patients. A total of 845 (8.8%) patients died in the hospital. Patients with anemia had higher hospital mortality (11.3% vs. 6.6%, unadjusted OR 1.82, 95% CI 1.58–2.10, p < 0.001). After multivariable regression, admission Hb and MCV were not significantly associated with hospital mortality (both p > 0.1), while admission RDW (adjusted OR 1.12 per 1%, 95% CI 1.07–1.18, p < 0.001) was significantly associated with hospital mortality. Hospital survivors with lower Hb, higher MCV, or higher RDW had lower post-discharge survival. Conclusion: Elevated RDW on admission was independently associated with higher hospital mortality in CICU patients. These data emphasize the importance of hematologic abnormalities for mortality risk stratification in CICU populations. Graphic abstract: [Figure not available: see fulltext.].

AB - Background: Anemia and elevated red cell distribution width (RDW) or mean corpuscular volume (MCV) are associated with an adverse prognosis in patients with cardiovascular disease and critical illness. Limited data exist regarding these associations in unselected cardiac intensive care unit (CICU) patients. Methods: Retrospective cohort study of CICU patients between January 1, 2007, and December 31, 2015, with a hemoglobin (Hb) level measured at admission. Multivariable regression was performed to determine predictors of hospital mortality, and Kaplan–Meier analysis was used to determine post-discharge survival. Results: We included 9644 patients with a mean age of 67.5 ± 15.1 years, including 3604 (37.4%) females. The median (IQR) values of Hb, MCV and RDW were 12.2 g/dL (10.6, 13.7), 90.7 fL (87.3, 94.2) fL, and 14.1% (13.3, 15.8), respectively. Anemia (admission Hb < 12 g/dL) was present in 4434 (46%) patients. A total of 845 (8.8%) patients died in the hospital. Patients with anemia had higher hospital mortality (11.3% vs. 6.6%, unadjusted OR 1.82, 95% CI 1.58–2.10, p < 0.001). After multivariable regression, admission Hb and MCV were not significantly associated with hospital mortality (both p > 0.1), while admission RDW (adjusted OR 1.12 per 1%, 95% CI 1.07–1.18, p < 0.001) was significantly associated with hospital mortality. Hospital survivors with lower Hb, higher MCV, or higher RDW had lower post-discharge survival. Conclusion: Elevated RDW on admission was independently associated with higher hospital mortality in CICU patients. These data emphasize the importance of hematologic abnormalities for mortality risk stratification in CICU populations. Graphic abstract: [Figure not available: see fulltext.].

KW - Anemia

KW - Cardiac intensive care unit

KW - Coronary care unit

KW - Mean corpuscular volume

KW - Mortality

KW - Red cell distribution width

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