Abstract
Aim:We aimed to investigate the prevalence of anemia at admission to intensive care unit (ICU), association between anemia and mortality, lengths of stay in hospital and ICU (LOS-H and LOS-ICU) in COVID-19 patients.
 Material and Methods:We retrospectively analyzed the data of 288 COVID-19 patients who needed ICU admission. Patients were divided into two groups: anemic and nonanemic. Demographic data, labaratory findings at ICU admission, LOS-H and LOS-ICU, mortality were compared between groups. A further classification was made based on hemoglobin levels; severe, moderate and mild anemic patients were analyzed. LOS-H, LOS-ICU and mortality were compared between patients with hemoglobin > 109 g/L and ≤ 109 g/L. Thus; moderate and severe anemic patients were compared to mild anemic and nonanemic patients. 
 Results: Anemia was detected in 137 (47.6%) patients upon admission to the ICU. Of those; 54 patients (39.4%) had mild, 76 patients (55.5%) had moderate, 7 patients (5.1%) had severe anemia. Anemic patients were older, had multiple comorbidities, lower hemoglobin and albumin, higher red cell distribution width (RDW), creatinine and procalcitonin levels. While LOS-H, LOS-ICU and mortality rates did not significantly differ between anemic and nonanemic patients; mortality rate was significantly high in patients with hemoglobin levels ≤ 109 g/L (moderate anemic) compared to patients with a hemoglobin level > 109 g/L (mild anemic and nonanemic). LOS-H and LOS-ICU were not significantly different between these patient groups. Only seven patients had severe anemia and all of these died.
 Conclusion: The results of this retrospective study showed that the anemia prevalence in ICU patients with COVID-19 was high, and mild anemia was not associated with higher mortality rates, while moderate and severe anemia were. Hemoglobin levels of anemic patients with COVID-19 should be closely monitored for timely detecting signs of disease progression.
Highlights
The coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) and has been pandemic across the whole world since December 2019
While LOS-H, LOS-intensive care unit (ICU) and mortality rates did not significantly differ between anemic and nonanemic patients; mortality rate was significantly high in patients with hemoglobin levels ≤ 109 g/L compared to patients with a hemoglobin level > 109 g/L
In this study we mainly found that; 1) the prevalence of anemia was high (47.6%) in COVID-19 patients at ICU admission suggesting that anemic patients are more likely to have severe disease, 2) anemia with hemoglobin levels < 130 g/L in men and < 120 g/L in women is not associated with higher mortality rates, longer LOS-H and LOS-ICU, 3) anemia with a hemoglobin level < 80 g/L is associated with higher mortality rates in ICU patients
Summary
The coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) and has been pandemic across the whole world since December 2019 It has, caused a significant burden on social life and all healthcare systems. Identification of risk factors that contribute to the development of the severe disease and death is essential to enable risk stratification and optimize hospital resources reallocation. In this regard some researchers studied the assocation between anemia and the severity or mortality of COVID-19 but had controversial results [2,3,4,5].
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