Abstract
Anaemia is common in critically ill patients and has been shown to be a predictor of mortality in general Intensive Therapy Unit (ITU). Patients with Corona Virus Infectious Disease 2019 (CV-19) have also been reported to be anaemic, more profound in those admitted to ITU. We report our experience in the management of anaemic CV-19 patients admitted to ITU between 1st March and 1st June 2020. Demographic and clinical variables collected included age, sex, BMI, Charlson comorbidity index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, haemoglobin concentration, blood transfusion, and mortality. 105 patients were admitted to the ITU with Severe Acute Respiratory Syndrome Coronavirus 2 disease requiring invasive mechanical ventilation and 73 patients with complete dataset were included in the study. Results: 36 patients (49%) were anaemic on admission, with 56 (77%) patients developing anaemia at some stage in the first 7 days of ITU stay. Anaemia at admission to ITU, a higher CCI and a higher APACHE II score were all independently associated with a blood transfusion (OR 12.5, 95% CI: 1.48 - 106, p = 0.02), (OR 1.95, 95% CI: 1.08 - 3.52, p = 0.03) and (OR 4.8, 95% CI: 1.48 - 15.6, p = 0.009) respectively. Univariable analysis showed that an increasing age (OR 2.15, 95% CI: 1.18 - 3.91, p = 0.01) and a higher APACHE II score (OR 1.60, 95% CI 1.01 - 2.54, p = 0.04) were significantly associated with mortality. There was also some evidence of an association with mortality for CCI, although the results for this variable were only of borderline statistical significance. Neither haemoglobin concentration (OR 1.09, 95% CI: 0.83 - 1.43, p = 0.55) or anaemia (OR 1.08, 95% CI: 0.41 - 2.85, p = 0.87) at admission to ITU was significantly associated with mortality. 13 patients received blood transfusions, with a mean (SD) pretransfusion Hb of 75.2 (12.02). These numbers were too small to identify any association between receiving blood transfusion and mortality.
Highlights
Anaemia is common in critically ill patients and has been shown to be a predictor of mortality in general Intensive Therapy Unit (ITU) [1] [2]
Demographic and clinical variables collected included age, sex, BMI, Charlson comorbidity index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, haemoglobin concentration, blood transfusion, and mortality. 105 patients were admitted to the ITU with Severe Acute Respiratory Syndrome Coronavirus 2 disease requiring invasive mechanical ventilation and 73 patients with complete dataset were included in the study
1100 Corona Virus Infectious Disease 2019 (CV-19) Polymerase Chain Reaction (PCR) positive patients were treated in our hospital during this period. 105 patients were admitted to the ITU with SARS-CoV-2 ARDS requiring invasive mechanical ventilation
Summary
Anaemia is common in critically ill patients and has been shown to be a predictor of mortality in general Intensive Therapy Unit (ITU) [1] [2]. Systemic inflammation frequently leads to anaemia due to its effect on erythropoiesis [6]. Independent of this viruses are known to interfere with iron metabolism potentially leading to anaemia [5] [7]-[13]. Unlike in general ITU patients, the association between anaemia and severity of the disease or mortality in critically ill CV-19 patients is highly debated [5] [14] [15] [16] [17] [18]. Our primary aim was to explore the prevalence of anaemia in critically ill SARS-CoV-2 patients. Analyses were performed to examine association between anaemia and patient factors; age, sex, BMI, CCI, APACHE II score and Hb concentration (Hb) with blood transfusion and mortality
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