Anemia at pediatric intensive care unit discharge: prevalence and risk markers

Pierre Demaret,André Mulder,Frédéric Lebrun,Stéphane Leteurtre,Marisa Tucci,Alain Duhamel,Hélène Behal,Oliver Karam,Jacques Lacroix

doi:10.1186/s13613-017-0328-8

Abstract

BackgroundAnemia is prevalent at pediatric intensive care unit (PICU) admission and incident during PICU stay, but little is known about anemia at PICU discharge. Anemia after critical illness is an important issue because it could impact post-PICU outcome. We aimed to estimate the prevalence of anemia at PICU discharge and to determine its risk markers.MethodsThis is an ancillary study of a prospective observational study on transfusion practices conducted in the PICU of a tertiary care children’s hospital. All children consecutively admitted to the PICU during a 1-year period were considered for inclusion. Data were prospectively collected from medical charts, except for hemoglobin (Hb) levels at PICU and hospital discharge that were collected retrospectively. Anemia was defined by an Hb concentration below the lower limit of the normal range for age.ResultsAmong the 679 children retained for analysis, 390 (57.4%) were anemic at PICU discharge. After multivariate adjustment, anemia at PICU admission was the strongest risk marker of anemia at PICU discharge. The strength of this association varied according to age (interaction): The odds ratio (OR) (95% CI) of anemia at PICU discharge was 4.85 (1.67–14.11) for 1–5-month-old infants anemic versus not anemic at PICU admission, and it was 73.13 (13.43, 398.19) for adolescents anemic versus not anemic at PICU admission. Children admitted after a non-cardiac surgery had an increased risk of anemia at PICU discharge [OR 2.30 (1.37, 3.88), p = 0.002]. The proportion of anemic children differed between age categories, while the median Hb level did not exhibit significant variations according to age.ConclusionsAnemia is highly prevalent at PICU discharge and is strongly predicted by anemia at PICU admission. The usual age-based definitions of anemia may not be relevant for critically ill children. The consequences of anemia at PICU discharge are unknown and deserve further scrutiny.

Highlights

Anemia is prevalent at pediatric intensive care unit (PICU) admission and incident during PICU stay, but little is known about anemia at PICU discharge
The proportion of anemic children was higher in neonates (70.9%) and adolescents, while it was lower in infants aged 1–5 months (30.5%) (Table 1, Fig. 3)
When analyzing the 386 children for whom an Hb level at hospital discharge was available, we found that a high proportion of children with anemia at PICU discharge were still anemic at hospital discharge (178/247, 72%)

Summary

Introduction

Anemia is prevalent at pediatric intensive care unit (PICU) admission and incident during PICU stay, but little is known about anemia at PICU discharge. Given the high prevalence and incidence of anemia at admission and during ICU stay and given that red blood cell (RBC) transfusion guidelines recommend a restrictive strategy for most critically ill patients [6, 7], it makes sense to wonder about anemia at ICU discharge. A Number of anemic children/total number of children in the age category (%) Hb hemoglobin, PICU pediatric intensive care unit that up to half of adults leaving the ICU with a Hb level < 100 g/L are still anemic 6 months after hospital discharge [10]

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