Admission Hemoglobin Research Articles

Effect of Prophylactic Tranexamic Acid on Peripartum Changes in Hemoglobin Concentration After Vaginal Delivery

Objective: To evaluate the effect of prophylactic intravenous tranexamic acid on postpartum hemoglobin concentration values compared to control. Methods: This is a randomized controlled study involving 80 parturients with no apparent risk for PPH in a tertiary hospital who were grouped into two of 40 each. Group A received 10iu of oxytocin intramuscularly with 1000mg of intravenous tranexamic acid within one minute of having vaginal delivery of the baby while group B received intramuscular oxytocin 10iu with 10mls of sterile water and served as the control group. The primary outcome measure was the difference in admission and postpartum hemoglobin concentration (Hemoglobin change). Result: During the study period, 80 parturients that were recruited, completed the study. The characteristics of the parturients in the two groups had no significant statistical difference in their demographic characteristics and admission parameters (P>0.05). The mean postpartum hemoglobin concentration was significantly higher in the tranexamic acid plus oxytocin group compared to placebo plus oxytocin group (10.28+ 0.59ml) versus (9.44+0.62ml) p<0.005. There was no major maternal side effect in both groups. Conclusion: When compared with placebo plus oxytocin, tranexamic acid plus oxytocin was more effective in reducing postpartum hemoglobin drop after vaginal delivery. Tranexamic acid plus oxytocin is therefore recommended to be part of the active management of the third stage of labor.

Prediction model for poor short-term prognosis in patients with chronic subdural hematoma after burr hole drainage: a retrospective cohort study.

Chronic subdural hematoma (CSDH) is a common condition in neurosurgery. With an aging population, there is increasing attention on the prognosis of patients following surgical intervention. We developed a postoperative short-term prognostic prediction model using preoperative clinical indicators, aiming to assist in perioperative medical decision-making and management. The dataset was randomly divided into training and validation cohorts. An mRS score greater than 2 one month after discharge was considered indicative of a poor prognosis. In the training cohort, the least absolute shrinkage and selection operator (LASSO) regression analysis was used for multivariate analysis to identify independent risk factors and construct a prediction nomogram for poor prognosis one month after discharge. The performance of the nomogram was assessed using the Receiver Operating Characteristic (ROC) curve and calibration curve. A Decision Curve Analysis (DCA) was also conducted to determine the net benefit threshold of the prediction model. Among the 505 participants, 18.8% (95/505) had a poor prognosis one month after discharge. The baseline characteristics did not significantly differ between the training cohort and the validation cohort. LASSO regression analysis in the training cohort reduced the predictors to four potential factors. Further multivariate logistic analyses in the training cohort identified four independent predictors: age, admission Glasgow Coma Scale (GCS) score, hemiparesis, and hemoglobin count. These predictors were incorporated into the nomogram prediction model. Internal validation using ROC analysis, calibration curves, and other methods demonstrated a strong correlation between the observed and predicted likelihood of poor prognosis one month after discharge. The visualized nomogram prediction model we developed for short-term postoperative prognosis of chronic subdural hematoma after burr hole drainage aids in predicting short-term outcomes and guiding clinical treatment decisions. Further external validation is needed in the future to confirm its effectiveness.

ThP6.6 - Enhancing Management Strategies: Exploring the Expansion of Low-Risk Criteria in Glasgow-Blatchford Scoring for Acute Upper Gastrointestinal Bleeding – A Retrospective Cohort Study

Abstract Aims Glasgow-Blatchford Scoring (GBS) determines the need for further interventions in patients presenting with acute upper gastrointestinal bleeding (AUGIB). We aimed to study whether we can safely expand low-risk criteria to patients with GBS 2 and manage them as urgent outpatient. Methods A retrospective study of consecutive adult patients who had inpatient endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, clinical and laboratory findings, GBS and endoscopic findings was analysed. Low-risk was defined as GBS 0-1 and high-risk as GBS ≥3. Results 150 patients were identified; 79 (58.7%) were male and median age of 63 years (IQR 53-76). Median total length-of-stay was 3.7 days (IQR 1.9=7.8). Similar to the low-risk group, patients with GBS 2 presented with lower range and frequency of symptoms as the high-risk group (p=0.0002). Severity correlated with admission haemoglobin (p=0.001) and urea count (p<0.0001) but not relevant comorbidities (p=0.560) and admission observations (p=0.456). The frequency of benign endoscopic findings in patients with GBS 2 were similar to the low-risk group with no malignant findings noted. This group also had similar rates of past and re-attendances for AUGIB and 30-day mortality of 0% to the low-risk group. Conclusion While our study has a small sample size, it suggests promising prospect that patients with GBS 2 may not need inpatient endoscopy. Future multi-centre studies are crucial to validate and strengthen this proposition. The potential advantages include decreased inpatient admissions, reduced healthcare costs, and alleviating pressures on emergency endoscopy unit.

Admission Hemoglobin Associated with Increased Mortality in Hip Fracture Surgical Patients: An Observational Study.

In hip fracture patients, who are mostly elderly, preexisting anemia can be worsened when combined with trauma and surgery. To this date, there is no unequivocal approach about transfusion thresholds. We analyzed hemoglobin (Hb) and hematocrit (Hct) levels at three time points in surgical patients with proximal femoral fractures (PFF) to see which levels were triggers for transfusions and whether transfusions were related to mortality after hospital discharge. A total of 956 patients were operated on from 1 January 2021 to 31 December 2022 at the University Hospital of Split and included in the study. There were more women (74%); 47% patients had admission Hb < 120 g/L. Transfusion was given preoperatively to 88, intraoperatively to 74 and postoperatively to 309 patients. Transfusion thresholds were as follows: Hb 84 g/L preoperatively, 99 intraoperatively and 83 postoperatively. After hospital discharge, 10.79% of patients died within the 1st month and 23% within 6 months. In the group of non-survivors, 60% of patients had admission Hb ≤ 117 g/L and the proportion of patients transfused preoperatively was two times higher. Preoperative transfusion thresholds could be set to higher levels for patients with surgically treated PFF. However, that could increase mortality even more. Further investigation is necessary.

Risk factors at admission of in-hospital dysglycemia, mortality, and readmissions in patients with type 2 diabetes and pneumonia

AimsIn-hospital dysglycemia is associated with adverse outcomes. Identifying patients at risk of in-hospital dysglycemia early on admission may improve patient outcomes. MethodsWe analysed 117 inpatients admitted with pneumonia and type 2 diabetes monitored by continuous glucose monitoring. We assessed potential risk factors for in-hospital dysglycemia and adverse clinical outcomes. ResultsTime in range (3.9–10.0 mmol/l) decreased by 2.9 %-points [95 % CI 0.7–5.0] per 5 mmol/mol [2.6 %] increase in admission haemoglobin A1c, 16.2 %-points if admission diabetes therapy included insulin therapy [95 % CI 2.9–29.5], and 2.4 %-points [95 % CI 0.3–4.6] per increase in the Charlson Comorbidity Index (CCI) (integer, as a measure of severity and amount of comorbidities). Thirty-day readmission rate increased with an IRR of 1.24 [95 % CI 1.06–1.45] per increase in CCI. In-hospital mortality risk increased with an OR of 1.41 [95 % CI 1.07–1.87] per increase in Early Warning Score (EWS) (integer, as a measure of acute illness) at admission. ConclusionsDysglycemia among hospitalised patients with pneumonia and type 2 diabetes was associated with high haemoglobin A1c, insulin treatment before admission, and the amount and severity of comorbidities (i.e., CCI). Thirty-day readmission rate increased with high CCI. The risk of in-hospital mortality increased with the degree of acute illness (i.e., high EWS) at admission. Clinical outcomes were independent of chronic glycemic status, i.e. HbA1c, and in-hospital glycemic status.

1023-P: Predictive Value of Admission Plasma Glucose and Hemoglobin A1c on Inpatient Glycemic Control Assessed by Continuous Glucose Monitoring (CGM) in Medicine and Surgery Persons with Diabetes

1023-P: Predictive Value of Admission Plasma Glucose and Hemoglobin A1c on Inpatient Glycemic Control Assessed by Continuous Glucose Monitoring (CGM) in Medicine and Surgery Persons with Diabetes

Dynamic observation and risk factors analysis of deep vein thrombosis after hip fracture.

To dynamically observe the occurrence of deep vein thrombosis (DVT) after a hip fracture and analyze of the risk factors affecting the dynamic alteration of DVT. Data of patients with hip fractures from January 1, 2017 to August 31, 2021 were collected. Patients were divided into DVT and non-DVT groups according to their daily Doppler ultrasonography findings. Survival analysis was used to describe dynamic changes in DVT occurrence with time. Log-rank tests were used to compare the influence of individual factors of patients with DVT occurrence, and a Cox proportional hazards regression model was used to identify the risk factors affecting the dynamic alteration of DVT occurrence. A total of 331 patients were included: 148(44.7%) had preoperative DVT, and 143 (96.6%) had DVT in the first 3days after admission. The probability of DVT was 0.42 on Day 1, 0.11 on Day 2, 0.10 on Day 3, 0.08 on Day 4, 0.20 on Day 5, and 0.00 on Day 6-7, with a median survival time of 3.30 d. Age>70 years, intertrochanteric fracture, admission hemoglobin<130g/L, and admission hematocrit<40% had a significantly higher occurrence rate of DVT. A hematocrit level of <40% (Hazard Ratio 2.079, 95% Confidence Interval:1.148-3.764, P = 0.016) was an independent risk factor for DVT. DVT after hip fractures mainly occurred in the first three days after admission, the trend was stabilized within one week, and day 1 had the highest rate of DVT incidence. Age, fracture type, HGB level, and Hct level affected dynamic occurrence of DVT. At constant other factors, Hct<40% was 2.079-fold incidence in the risk of preoperative DVT formation than those with Hct≥40% after hip fracture.

SARS-CoV-2 PCR cycle threshold value at admission might not be a good predictor of in-hospital COVID-19-associated AKI.

Acute kidney injury (AKI) is a prevalent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and a predictor of disease severity and mortality; furthermore, a prompt diagnosis and treatment of this complication may enhance COVID-19 prognosis. Therefore, we aim to investigate potential risk factors for SARS-CoV-2-associated AKI, including SARS-CoV-2 PCR cycle threshold value (CT value), which correlation with AKI is conflicting. This case-control study included 110 hospitalized patients with SARS-CoV-2-associated AKI as cases and 110 random SARS-CoV-2 hospitalized patients as controls. Reverse transcription real-time PCR of admission nasopharyngeal swabs evaluated E gene cycle thresholds. Additional clinical and paraclinical information extracted from medical records. The patient's status at discharge, and 14 and 30 days after discharge. Therefore, after adjusting for age and gender, the correlation between variables was assessed. SARS-CoV-2 AKI is significantly associated with age above 60, hypertension, diabetes mellitus, ischemic heart disease, and underlying kidney diseases. Abnormal admission hemoglobin or alkaline phosphatase, proteinuria or hematuria in urine sediment, and abnormal creatinine during hospitalization were the paraclinical features correlated to SARS-CoV-2 AKI. AKI group demonstrated greater in-hospital, 14- and 30-day mortality. Nevertheless, this study did not evidence a correlation between the admission CT value and mortality or AKI. Admission CT values provide limited information regarding the dynamic viral load and varying hospitalization time points; thus, they may not be reliable for predicting the prognosis and complications of COVID-19 in all populations. Further studies with serial CT measurements or symptom onset time adjustment are recommended.

Development and validation of a trauma frailty scale in severely injured patients: the Nottingham Trauma Frailty Index.

Frailty greatly increases the risk of adverse outcome of trauma in older people. Frailty detection tools appear to be unsuitable for use in traumatically injured older patients. We therefore aimed to develop a method for detecting frailty in older people sustaining trauma using routinely collected clinical data. We analyzed prospectively collected registry data from 2,108 patients aged ≥ 65 years who were admitted to a single major trauma centre over five years (1 October 2015 to 31 July 2020). We divided the sample equally into two, creating derivation and validation samples. In the derivation sample, we performed univariate analyses followed by multivariate regression, starting with 27 clinical variables in the registry to predict Clinical Frailty Scale (CFS; range 1 to 9) scores. Bland-Altman analyses were performed in the validation cohort to evaluate any biases between the Nottingham Trauma Frailty Index (NTFI) and the CFS. In the derivation cohort, five of the 27 variables were strongly predictive of the CFS (regression coefficient B = 6.383 (95% confidence interval 5.03 to 7.74), p < 0.001): age, Abbreviated Mental Test score, admission haemoglobin concentration (g/l), pre-admission mobility (needs assistance or not), and mechanism of injury (falls from standing height). In the validation cohort, there was strong agreement between the NTFI and the CFS (mean difference 0.02) with no apparent systematic bias. We have developed a clinically applicable tool using easily and routinely measured physiological and functional parameters, which clinicians and researchers can use to guide patient care and to stratify the analysis of quality improvement and research projects.

Association between admission hemoglobin level and prognosis in sepsis patients based on a critical care database

This study aimed to explore the association between admission hemoglobin level and clinical outcomes in sepsis based on Medical Information Mart for Intensive Care IV(MIMIC-IV) database. It was a retrospective study. Sepsis patients in the database were included. Data extraction from MIMIC-IV was performed by PostgreSQL 9.6 software. Three different models including crude model (adjusted for none), model I (adjusted for gender and age) and model II (adjusted for all potential cofounders) were constructed. A generalized liner model and a smooth fitting curve for indicating the relationship between hemoglobin level and 30-day mortality were performed. 6249 septic patients with a 30.18% of 30-day mortality were included. With 1 g/dl increment in hemoglobin level, the values of odds ratio (OR) in crude model, model I and model II were 0.96 (95% confidential interval (CI) 0.94–0.99, P = 0.0023), 0.96 (95%CI 0.93–0.98, P = 0.0010) and 0.87 (95%CI 0.79–0.95, P = 0.0020), respectively. The smooth fitting curve indicated a non-linear relationship and the turning point was 7.2 g/dl. Compared the hemoglobin group < 7.2 g/dl, the risk of 30-day mortality significantly decreased by 32% in the hemoglobin group ≥ 7.2 g/dl (OR = 0.68, 95%CI 0.51–0.93, P = 0.0142). The non-linear relationship between admission hemoglobin level and 30-day mortality in sepsis was found. Hemoglobin supplementation might be beneficial for septic patients with hemoglobin level < 7.2 g/dl.

Secondary polycythemia in acutely ill COVID-19 patients is associated with higher mortality but not markedly higher thrombotic risk

Secondary polycythemia is commonly observed among patients with chronic pulmonary diseases. However, its significance in the context of Coronavirus disease 2019 (COVID-19) is unknown. We retrospectively evaluated a total of 5872 hospitalized COVID-19 patients with mostly severe and critical symptoms, and without prior or subsequently diagnosed myeloproliferative neoplasm. Patients were stratified based on admission hemoglobin into four subgroups: anemia (hemoglobin <120 g/L for females and 130 g/L for males), normal hemoglobin, mild (hemoglobin 160–165 g/L for females and 165–185 g/L for males) and severe polycythemia (hemoglobin >165 g/L for females and >185 g/L for males). Among 5872 patients, a total of 158 (2.7%) had mild and 25 (0.4%) severe polycythemia. Polycythemia was significantly associated with higher respiratory and functional impairment, reduced plasma volume, higher serum osmolarity and comorbidity burden specific to the degree of polycythemia. Patients presenting with mild (odds ratio (OR) = 1.63, p = .003) and severe polycythemia (OR = 4.98, p < .001) had increased risk of death in comparison to patients with normal hemoglobin, whereas no significant associations with venous thromboembolism, arterial thrombosis nor major bleeding were observed. Anemia was associated with higher risk of death (OR = 1.42, p < .001), venous thromboembolism (OR = 1.34, p < .006) and major bleeding (OR = 2.27, p < .001) in comparison to normal hemoglobin. Associations of polycythemia and anemia with mortality diminished, and anemia with venous thromboembolism and major bleeding persisted, after multivariate adjustments for age, sex, comorbidities, COVID-19 severity and functional status. Secondary polycythemia in hospitalized COVID-19 patients without prior of subsequently diagnosed myeloproliferative neoplasm is rare and is associated with high mortality, increasing with degree of polycythemia, but not markedly higher thrombotic risk.

Abstract WP176: Hemoglobin Decrement is Associated With Ischemic Lesions on Brain MRI of Patients With Acute Intracerebral Hemorrhage

Background: We have previously identified that hemoglobin decrements and new-onset anemia during an intracerebral hemorrhage (ICH) hospitalization is frequent, rapid, and associates with poor outcome. Though this association may be related to impaired cerebral oxygen delivery, it is unclear whether these changes relate to cerebral ischemia. We investigated the relationship of hemoglobin decrements over time and ischemic lesions on brain MRI during an ICH hospitalization. Methods: Consecutive patients with acute spontaneous ICH enrolled into a single-center, prospective cohort study between 2009 and 2019 were assessed. Patients who had a brain MRI and serial hemoglobin measurements were included. Change in hemoglobin from admission to date of brain MRI (delta Hgb) was defined as the exposure. The outcome was the presence of remote ischemic lesions, defined as foci of diffusion restriction &gt;10 mm away from the hematoma on brain MRI. A regression model assessed relationships between delta Hgb and DWI brain lesions, adjusting for baseline demographics, ICH severity, and time to MRI. Separate sensitivity models were adjusted for admission systolic blood pressure and hemoglobin. Results: We identified 189 ICH patients with brain MRI and serial hemoglobin measurements during their hospitalization. The mean age was 66.5 (SD 14.8) and 49.2% were female. Mean admission hemoglobin was 13.5 g/dL (SD 2.0), mean change in hemoglobin from admission to day of MRI was -1.6 (SD 1.6), median time from ICH onset to MRI was 2 (IQR 1-4) days, and 31.7% of patients had ischemic lesions on MRI. We identified an association of greater decrements in hemoglobin with ischemic lesions in our primary model (adjusted OR 0.79, 95%CI 0.64-0.99, p=0.04). Sensitivity analyses adjusting for admission systolic blood pressure and hemoglobin did not change this association. Conclusions: Greater hemoglobin decrements associate with remote ischemic lesions on brain MRI of patients with acute ICH. Further work is needed to assess drivers of anemia after ICH and possible causal mechanisms for ischemic brain injury to assess whether anemia is a modifiable treatment target to improve ICH outcomes.

Comportamiento de la urgencia ginecológica durante la pandemia de COVID-19

Introduction: The COVID-19 pandemic has meant a decrease in gynecological visits to the emergency department. Objective: To characterize the attending in the gynecological emergency service, evaluating the amount of admissions, hospitalizations, need for surgical intervention, morbidity factors, among others, compared to the pre-pandemic situation. Method: A non-concurrent cohort study of hospitalized patients was carried out through a spontaneous attending to the gynecological emergency service between weeks 12 and 28 of 2019 and 2020 at the Hospital Clinico of the Pontificia Universidad Catolica, in Santiago (Chile). Different morbidity factors were measured: admission diagnosis, surgical intervention, surgical complication, hospital stay, admission hemoglobin, and need for transfusion of blood units. Results: A total of 511 visitors to the emergency service were registered between weeks 12 and 28 of 2019, compared to 196 in 2020. In 2019 and 2020, 103 and 72 women were hospitalized respectively (odds ratio [OR]: 2.3). Admission for pregnancy loss decreased (24 vs. 12;p = 0.01), while admission for postmenopausal bleeding increased (9 vs. 22;p = 0.01). There was no change in the surgical interventions performed (86.4% vs. 84.7%;p = 0.7). The hospital stays increased (2.3 vs. 3.1;p < 0.0001) and the need for blood transfusion (2 vs. 7;p = 0.02;OR: 5.4;confidence interval: 1.09-26). Conclusions: The COVID-19 pandemic caused a decrease in spontaneous attending for gynecological pathology at the emergency service, causing an increase in the attend/admission ratio and greater morbidity in hospitalized patients characterized by a greater need for blood transfusion and an increase on the hospital stay. © 2021 Sociedad Chilena de Obstetricia y Ginecologia.

The occurrence of Hospital-Acquired Pneumonia is independently associated with elevated Stress Hyperglycaemia Ratio at admission but not elevated blood glucose

BackgroundThe association between stress-induced hyperglycaemia (SIH) and increased infection rates in hospitalised subjects is well-known. It is less clear if SIH at admission independently drives new-onset infections. We assessed the relationship between early exposure at admission to both the Stress Hyperglycaemia Ratio (SHR) and Blood Glucose (BG) with Hospital-Acquired Pneumonia (HAP). MethodsThis observational retrospective study included those with length-of-stay > 1 day, BG within 24 h of admission and recent haemoglobin A1c. SIH was defined as BG ≥ 10 mmol/L, or SHR ≥ 1.1, measured at both admission and as a 24-hour maximum. Multivariable analyses were adjusted for length-of-stay, age, mechanical ventilation, and chronic respiratory disease. ResultsOf 5,339 eligible subjects, 110 (2.1%) experienced HAP. Admission SHR ≥ 1.1 was independently associated with HAP (OR 3.04, 95% CI 1.98–4.68, p < 0.0001) but not BG ≥ 10 mmol/L (OR 0.65, 95% CI 0.41–1.03, p = 0.0675). The association with SHR strengthened using maximum 24-hour values (OR 3.37, 95% CI 2.05–5.52, p < 0.0001) while BG ≥ 10 mmol/L remained insignificant (OR 0.96, 95% CI 0.63–1.46, p = 0.86). Of those experiencing HAP 40 (36.4%) occurred in subjects with no recorded BG ≥ 10 mmol/L but SHR ≥ 1.1. ConclusionSIH at admission defined as SHR ≥ 1.1, but not the conventional marker of BG ≥ 10 mmol/L, was independently associated with the subsequent onset of HAP, commonly at BG < 10 mmol/L.

The relationship of the hemoglobin to serum creatinine ratio with long-term mortality in patients with acute coronary syndrome: A retrospective study.

Acute coronary syndrome (ACS) is an urgent clinical condition of cardiovascular diseases. The present study evaluated the predictive efficacy of the hemoglobin to serum creatinine ratio (Hgb/Cr) on long-term mortality in patients with ACS. The ratio, representing the proportion of the 2 values, is cheap, practical, and very easy to calculate at the bedside. Our study included 475 patients who were admitted to the coronary intensive care unit with a diagnosis of ACS and who underwent coronary angiography. The Hgb/Cr ratio was calculated by dividing the admission hemoglobin by the admission serum creatinine. All patient data were collected from the electronic hospital information system, patient files, and the hospital's archive. A comparison of the patients laboratory findings revealed that the Hgb/Cr ratios differed significantly between the survivor and non-survivor group [16.6 (7.7-49) vs 13.8 (4.91-32.8), respectively; P < .001]. A univariate Cox regression analysis showed that the Hgb/Cr ratio was statistically significant in predicting long-term mortality (0.836; 95% confidence interval [CI]: 0.781-0.895; P < .001). After adjusting the model by adding clinically and statistically significant variables, the Hgb/Cr ratio was still an independent predictor of long-term mortality (0.886; 95% CI: 0.815-0.963; P = .004). The Hgb/Cr ratio's discriminant ability was tested with an receiver operating characteristic curve analysis. The Hgb/Cr ratio's area under the curve value was 0.679 (95% CI: 0.609-0.750; P < .001). A survival analysis using the Kaplan-Meier curve of the 2 Hgb/Cr ratio groups (according to cutoff value) revealed that the low-Hgb/Cr group had a significantly higher mortality rate than high-Hgb/Cr group. The Hgb/Cr ratio was found to be an independent predictor of long-term mortality in ACS patients.

A reassessment of hemoglobin and hematoma expansion in intracerebral hemorrhage

BackgroundIn patients with spontaneous intracerebral hemorrhage (ICH), prior studies identified an increased risk of hematoma expansion (HE) in those with lower admission hemoglobin (Hgb) levels. We aimed to reproduce these findings in an independent cohort. MethodsWe conducted a cohort study of patients admitted to a Comprehensive Stroke Center for acute ICH within 24 hours of onset. Admission laboratory and CT imaging data on ICH characteristics including HE (defined as >33% or >6 mL), and 3-month outcomes were collected. We compared laboratory data between patients with and without HE and used multivariable logistic regression to determine associations between Hgb, HE, and unfavorable 3-month outcomes (modified Rankin Scale 4-6) while adjusting for confounders including anticoagulant use, and laboratory markers of coagulopathy. ResultsAmong 345 patients in our cohort (mean [SD] age 72.9 [13.7], 49% male), 71 (21%) had HE. Patients with HE had similar Hgb versus those without HE (mean [SD] 13.1 [1.8] g/dl vs. 13.1 [1.9] g/dl, p=0.92). In fully adjusted multivariable models, Hgb was not associated with HE (OR per 1g/dl 1.01, 95% CI 0.86 -1.17, p = 0.94), however higher admission Hgb levels were associated with lower odds of unfavorable 3-month outcome (OR 0.83 per 1 g/dl Hgb, 95% CI 0.72–0.96, p=0.01). ConclusionWe did not confirm a previously reported association between admission Hgb and HE in patients with ICH, although Hgb and HE were both associated with poor outcome. These findings suggest that the association between Hgb and poor outcome is mediated by other factors.

Preoperative hemoglobin levels and mortality outcomes after hip fracture patients

PurposeHip fracture surgery is associated with a risk of morbidity and mortality, with admission hemoglobin levels being a significant predictor of mortality risk. The aim of this study is to evaluate the relationship between the preoperative hemoglobin (Hb) levels and mortality in patients who underwent hip fracture surgeries, with the goal of enhancing prognosis prediction and reducing complications within this patient subset. In addition, to assess the characteristics of patients at a higher risk of postoperative mortality.MethodsThis retrospective study was conducted at Jordan University Hospital, a single tertiary care and educational center. It included patients with hip fractures who underwent surgical repair at the Department of Orthopedic Surgery and were recruited between December 2019 and February 2022. We examined the relationships between preoperative hemoglobin status and variables such as age at admission, gender, fracture type, surgery type, comorbidities, duration of hospital stay, intensive care unit (ICU) admission, and survival outcomes.ResultsWe included 626 patients; the mean age was 76.27 ± 9.57 years. 3-month and 6-month mortality rates were 11.2% and 14.1%, respectively. The highest mortality was observed in patients aged over 80 years (n = 53/245, 21.6%), and in male patients (n = 53/300, 17.7%). The Hb level upon admission was lower in individuals who died within 6 months compared to those who survived (10.97 ± 2.02 vs. 11.99 ± 2.39, p < 0.001). In multivariate analysis, the independent factors that were statistically significant in the model included gender (OR = 1.867; 95% CI 1.122–3.107, p = 0.016), age (OR = 1.060; 95% CI 1.029–1.092; p < 0.001), hemoglobin level upon admission (OR = 0.827; 95% CI 0.721–0.949; p = 0.007), history of renal disease (OR = 1.958; 95% CI 1.014–3.784; p = 0.045), length of hospital stay (OR = 1.080; 95% CI 1.036–1.126; p < 0.001), and ICU admission (OR = 1.848; 95% CI 1.049–3.257; p = 0.034).ConclusionOur study illustrates that low hemoglobin levels, history of renal disease, along with male gender, advanced age, extended hospital stays, and ICU admission were significantly associated with 6-month mortality. Future investigations should consider assessing varying degrees of anemia based on hemoglobin concentrations to provide a more comprehensive understanding of anemia’s impact on mortality.Mini-abstractThis study investigated the relationship between preoperative hemoglobin levels, patient characteristics, and mortality in patients who underwent hip fracture surgeries. The results showed that lower hemoglobin levels, history of renal disease, male gender, advanced age, extended hospital stays, and ICU admission were significant predictors for mortality.

Analysis of the diagnostic utility of Glasgow-Blatcford Score, Rockall Score, AIMS65 Score, BUN-to-albumin ratio and BUN-to-creatinine ratio for predicting the need for transfusion in upper gastrointestinal bleeding

Objective: This study aimed to compare the predictive accuracy of commonly used risk scores in predicting the need for transfusion among patients with upper gastrointestinal bleeding (UGIB). Material and Methods: This retrospective diagnostic utility study was conducted at a tertiary care academic hospital. The primary outcome was the diagnostic accuracy of the Glasgow-Blatchford Score (GBS), the Rockall Score, the AIMS65 Score, the BUN-to-albumin ratio (BAR), and the BUN-to-creatinine ratio (BCR) in the prediction of transfusion in UGIB. Results: Results from the study showed that 75% of the 104 patients included in the study received blood transfusions, with a median of 3 (IQR 2 - 4) units. Admission hemoglobin and hematocrit values were higher in the non-transfusion group (p&lt;0.001 for both comparisons). The GBS (AUC 0.790 [95% CI 0.699 - 0.864]; p&lt;0.001), AIMS65 (AUC 0.672 [95% CI 0.573 - 0.761]; p=0.001), and BAR (AUC 0.625 [95% CI 0.525 - 0.718, p=0.04) were found to be useful diagnostic indices in predicting transfusion administration, with ideal cut-offs of &gt;0, &gt;10.75, and &gt;0, respectively. But Rockall and BCR were not found to be useful diagnostically. The study suggests that these indices can be used as decision tools for transfusion administration in patients with acute upper gastrointestinal bleeding. Conclusion: The GBS demonstrated superior accuracy compared to AIMS65 and BAR, while Rockall score and BCR were found to be ineffective. The GBS may therefore be useful to clinicians when assessing the potential need for blood transfusions in patients with UGIB.

Prognostic impact of in-hospital hemoglobin decline in non-overt bleeding ICU patients with acute myocardial infarction

BackgroundThe prognostic value of in-hospital hemoglobin drop in non-overt bleeding patients with acute myocardial infarction (AMI) admitted to the intensive care unit (ICU) remains insufficiently investigated.MethodsA retrospective analysis was performed based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. 2,334 ICU-admitted non-overt bleeders diagnosed with AMI were included. In-hospital hemoglobin values (baseline value on admission and nadir value during hospitalization) were available. Hemoglobin drop was defined as a positive difference between admission and in-hospital nadir hemoglobin. The primary endpoint was 180-day all-cause mortality. The time-dependent Cox proportional hazard models were structured to analyze the connection between hemoglobin drop and mortality.Results2,063 patients (88.39%) experienced hemoglobin drop during hospitalization. We categorized patients based on the degree of hemoglobin drop: no hemoglobin drop (n = 271), minimal hemoglobin drop (< 3 g/dl; n = 1661), minor hemoglobin drop (≥ 3 g/dl & < 5 g/dl, n = 284) and major hemoglobin drop (≥ 5 g/dl; n = 118). Minor (adjusted hazard ratio [HR] = 12.68; 95% confidence interval [CI]: 5.13–31.33; P < 0.001) and major (adjusted HR = 13.87; 95% CI: 4.50-42.76; P < 0.001) hemoglobin drops were independently associated with increased 180-day mortality. After adjusting the baseline hemoglobin level, a robust nonlinear relationship was observed in the association between hemoglobin drop and 180-day mortality, with 1.34 g/dl as the lowest value (HR = 1.04; 95% CI: 1.00-1.08).ConclusionIn non-overt bleeding ICU-admitted patients with AMI, in-hospital hemoglobin drop is independently associated with higher 180-day all-cause mortality.

Patient Controlled Analgesia for Vaso-Occlusive Episodes in Children: A Retrospective Study.

To describe Patient-Controlled Analgesia (PCA) administration in pediatric patients admitted with sickle cell vaso-occlusive episode (VOE). This single-center retrospective study included all inpatient hematology admissions for VOE between 2014 and 2020. PCA-ratio was calculated as the ratio of bolus over continuous IV opioids dose, and time to PCA adjustment as time between first PCA order and a subsequent order that increased dosing or changed opioid medication. A total of 866 encounters (172 unique patients) with PCA for VOE were included. The mean age was 15.4 years old (SD=5.0). On average, after admission (hospital arrival), the first opioid dose was given at 1 hour, PCA started at 3.5 hours, and mean length of stay was 4.3 days (SD=2.5). The mean initial PCA-ratio was 1.7 (SD=0.6). There were no significant associations between age, gender, initial pain score, or admission hemoglobin and PCA-ratio (linear regression model P=0.443). In 24.7% of encounters, the PCA was adjusted within 6 hours. After adjusting by age and gender, lower admission pain scores (OR=1.15, P=0.004), lower PCA-ratio (OR=2.1, P=0.003), longer time to PCA start (OR=1.2, P=0.001), and no adjuvant ketamine (OR=2.4, P < 0.001) were associated with PCA unadjusted within 6 hours. At our institution, patients with VOE received opioids and PCA within the first hours of admission. PCAs were started at a ratio of 1.5-1.8, considered normal continuous. While no specific PCA-ratio was clearly superior for pain control, lower ratios (high continuous infusion) were associated with not requiring PCA adjustments at 6 hours. Prospective studies are needed.