Nonanemic Patients Research Articles

Right ventricular function and anemia in heart failure with preserved ejection fraction.

Anemia is a common complication in patients with heart failure and is associated with left ventricular systolic dysfunction. However, its role in right ventricular (RV) function has not been evaluated. We retrospectively analyzed the electronic medical data of 1,014 Heart Failure with Preserved Ejection Fraction (HFpEF) patients to evaluate the relationship between anemia and RV dysfunction in patients with HFpEF and whether this relationship is influenced by classical risk factors such as smoking and hypertension. The study showed that anemic patients were older and had significantly higher New York Heart Association functional class and tricuspid regurgitation (TR) than non-anemic patients. The level of hemoglobin (Hb) had a weak negative linear correlation with NT-pro-BNP (log-transform, r = 0.30, P < 0.0001) and a positively correlation with the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio (r = 0.44, P < 0.0001). Multivariate linear regression analysis shows that the degree of anemia, atrial fibrillation, and TR were independently associated with the TAPSE/PASP ratio. Anemia in HFpEF is associated with RV dysfunction, and this relationship is not affected by classical risk factors, such as smoking, hypertension, and diabetes.

Could Hepcidin Be a New Biomarker in Patients with Idiopathic Pulmonary Fibrosis (IPF)?

Objectives: Hepcidin is a biomarker produced by hepatocytes in chronic disease anemia and is known to increase during chronic inflammation. This study compares the hepcidin levels in idiopathic pulmonary fibrosis (IPF) patients and controls, evaluating its relationship with anemia and systemic inflammation in IPF patients. Methods: This study included 82 IPF patients and 31 controls. Hepcidin levels were compared between the two groups. In the IPF group, the hepcidin and anemia parameters were compared between anemic and non-anemic patients. The significance between the hepcidin and systemic inflammation parameters such as Erythrocyte Sedimentation Rate, CRP (C-reactive protein) levels, ferritin levels, and the Systemic Immune-Inflammation Index (SII) was investigated. Erythrocyte Sedimentation Rate, C-reactive protein (CRP) levels, and ferritin levels were measured using automated analyzers. Hepcidin and erythropoietin (EPO) levels were determined using ELISA kits. Results: A significant difference in hepcidin levels was found between the IPF and control groups (37.13 ± 14.92 vs. 25.77 ± 11.25, p < 0.001). No significant difference in hepcidin levels was found between anemic and non-anemic IPF patients (38.25 ± 16.2 vs. 36.7 ± 14.6, p = 0.719). No significant correlation was found between hepcidin levels and anemia parameters (serum iron, ferritin, vitamin B12, serum transferrin, transferrin saturation, total iron-binding capacity, hemoglobin, folate, and erythropoietin) in IPF patients. Despite significant differences in the systemic inflammation parameters (ferritin and CRP) between patients and controls, no significant correlation was found between their hepcidin and systemic inflammation parameters. Conclusions: Our study demonstrates that the hepcidin levels in IPF patients are elevated independently of anemia and systemic inflammation. We propose that hepcidin could be a potential biomarker to be investigated in IPF patients.

Prognostic impact of iron deficiency in new-onset chronic heart failure: Danish Heart Failure Registry insights.

Iron deficiency (ID) is prevalent in chronic heart failure (HF) but lacks a consensus definition. This study evaluates the prevalence and the prognostic impact of ID using different criteria on all-cause and cardiovascular mortality, as well as first hospitalization for HF in patients with new-onset chronic HF. In this nationwide registry-based cohort, we explored four definitions of ID: the current European Society of Cardiology (ESC) guidelines [ferritin <100ng/mL or ferritin 100-299ng/mL and transferrin saturation (TSAT) <20%], ferritin level <100ng/mL, TSAT<20% and serum iron ≤13μmol/L. Patients were identified through the Danish Heart Failure Registry. Of 9477 new-onset chronic HF patients registered in the Danish Heart Failure Registry from April 2003 to December 2019, we observed ID prevalence rates ranging from 35.8% to 64.3% depending on the ID definition used. Among patients with ID defined by iron ≤13μmol/L or TSAT<20%, 26% and 15.5%, respectively, did not meet the ESC guidelines definitionfor ID. Conversely, 11% of patients meeting the ESC criteria exhibited serum iron >13μmol/L and TSAT>20%. Regardless of anaemia status, ID defined by TSAT<20% or serum iron ≤13μmol/L was associated with all-cause mortality [non-anaemic, hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.30-1.89 and HR: 1.47, 95% CI: 1.24-1.73; anaemic, HR: 1.22, 95% CI: 1.07-1.38 and HR: 1.25, 95% CI: 1.09-1.44, respectively] and cardiovascular mortality (non-anaemic, HR: 2.21, 95% CI: 1.59-3.06 and HR: 1.47, 95% CI: 1.12-1.95; anaemic, HR: 1.37, 95% CI: 1.11-1.69 and HR: 1.28, 95% CI: 1.02-1.61, respectively), as well as increased risk of first hospitalization for HF (non-anaemic, HR: 1.28, 95% CI: 1.09-1.1.50 and HR: 1.27, 95% CI: 1.10-1.46; anaemic, HR: 1.25, 95% CI: 1.08-1.44 and HR: 1.22, 95% CI: 1.05-1.42, respectively). ID defined by ESC guidelines was associated with all-cause and cardiovascular mortality only in non-anaemic patients (HR: 1.41, 95% CI: 1.18-1.1.70 and HR: 1.58, 95% CI: 1.18-2.12.). Furthermore, the ESC guideline definition was associated with increased risk of first hospitalization for HF, regardless of anaemia status (non-anaemic, HR: 1.26, 95% CI: 1.08-1.1.47; anaemic, HR: 1.34, 95% CI: 1.17-1.53). ID, when defined by TSAT<20% or serum iron ≤13μmol/L, is associated with increased risk of all-cause and cardiovascular mortality, as well as first hospitalization for HF in patients with new-onset chronic HF, regardless of anaemia status. Conversely, ID defined as ESC guidelines is associated with all-cause and cardiovascular mortality only in non-anaemic patients.

Could Anemia Impact the Severity of Infections? COVID-19 as an Example.

The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study from the UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. A retrospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p<0.001). Intensive care unit (ICU) admission was almost 3 times higher among anemic patients compared to nonanemic (AOR:2.83,95% CI:1.89-4.25, p<0.001). In addition, the overall mortality rate of 2.8% (n=87) was 2.5-fold higher in anemic than nonanemic patients (OR:2.56, CI: 1.49-4.06, p<0.001). Moreover, older age (≥48-year-old) and male gender were independent predictors for severe illness (Age: OR=1.26, CI:1.07-1.51, p=0.006; Gender: OR:1.43,CI:1.15-1.78, p<0.001)) and ICU admission (Age: OR:2.08, CI:1.47-2.94, p<0.001; Gender: OR: 1.83, CI:1.12-3.00, p=0.008) whereas only age ≥48 years old contributed to higher mortality rate (OR:1.60, CI:1.04-2.46, p=0.034). Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

Impact of various iron deficiency definitions on mortality risk in chronic heart failure across the spectrum of left ventricular ejection fraction spectrum

Abstract Introduction Iron deficiency (ID) is prevalent in chronic heart failure (HF) but lacks a consensus definition. Purpose This study evaluates the prevalence of ID and its association with all-cause mortality and first hospitalization for HF, using current European Society of Cardiology (ESC) guidelines, transferrin saturation (TSAT) &amp;lt;20%, ferritin &amp;lt;100 ng/ml, and serum iron ≤13 μmol/L as ID criteria. Methods and Results Of 8587 new-onset HF patients registered in the Danish Heart Failure Registry from April 2003 to July 2021, we found varying ID prevalence (35.4% to 67%) based on different definitions. In heart failure with reduced ejection fraction (HFrEF) patients, irrespective of anemia, ID defined by TSAT &amp;lt;20% and serum iron ≤13 μmol/L was associated with all-cause mortality (non-anemic, HR: 1.42, 95% CI:1.22-1.64 and HR: 1.25, 95% CI: 1.1-1.43; anemic, HR: 1.22, 95% CI: 1.1-1.35 and HR: 1.26, 95% CI: 1.12-1.41, respectively) and first HF hospitalization (non-anemic, HR:1.41, 95% CI:1.23-1.62, HR: 1.33, 95% CI: 1.18-1.51; anemic, HR:1.27, 95% CI:1.12-1.45 and HR: 1.26, 95% CI:1.09-1.45, respectively). ID per ESC guidelines was only associated to mortality in non-anemic HFrEF (HR: 1.24, 95% CI:1.09-1.42) and first HF hospitalization in HFrEF, irrespective of anemia (non- anemic, HR:1.24, 95% CI:1.09-1.42; anemic, HR:1.35, 95% CI:1.2-1.52). No association was observed between the various definitions and outcomes in patients with heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction. Conclusion ID, when defined by TSAT &amp;lt;20% or serum iron ≤13 μmol/L, is associated with increased mortality and first hospitalization in HFrEF patients, regardless of anemia. Conversely, ID as per ESC guidelines is associated with mortality in non-anemic HFrEF patients and first hospitalization in HFrEF, irrespective of anemia status.Figure 1:Forest plot mortalityFigure 2:Forest plot hospitalization

Prevalence of Anemia in Patients With Rheumatoid Arthritis Presenting at Multi-organization Tertiary Care Hospitals.

Rheumatoid arthritis (RA) patients often have anemia, which is frequently made worse by the severity of the illness and ongoing inflammation. The objective of this study is to determine the prevalence of anemia among patients with RA presenting at a tertiary care hospital and to explore the relationship between anemia and various clinical parameters of RA. This cross-sectional research evaluated anemia in 330 RA patients in three different hospitals in Pakistan between January and December of 2023. Ages 18 and above, RA diagnosis as defined by the American College of Rheumatology, and permission were the inclusion criteria. Incomplete data or secondary anemic causes were the exclusion criteria. Medical records and interviews were used to gather information on demographics, hemoglobin levels, inflammatory markers, and the severity of RA. SPSS was utilized for the statistical analysis, with significance set at p < 0.05 and Chi-square testing employed to look for relationships between anemia. In this study of 330 RA patients, anemia was present in 180 patients (54.55%). The mean hemoglobin level among these patients was 11.41 ± 1.87 g/dL, and the red blood cell count averaged 4.26 ± 0.69 million/µL. Anemic patients had a higher Disease Activity Score (DAS28) with a mean of 5.23 ± 1.42, compared to 4.98 ± 1.35 in the 150 non-anemic patients (45.45%). Elevated C-reactive protein (CRP) levels were observed in 150 (83.33%) of the anemic patients, with a mean CRP of 28.79 ± 12.56 mg/L, while 160 (88.89%) of the anemic patients had an elevated erythrocyte sedimentation rate (ESR), with a mean ESR of 45.17 ± 16.29 mm/hr. Significant associations were found between anemia and longer disease duration (p = 0.042), higher RA severity (p = 0.002), and increased inflammatory markers (p < 0.001). Anemia is prevalent among RA patients and is significantly associated with higher disease severity, longer disease duration, and elevated inflammatory markers.

Pre-operative CBC reflex testing prior to cardiac surgery identifies treatable causes of anemia

Abstract Blood transfusion during or after cardiac surgery has been linked to poor patient outcomes. It is therefore desirable to optimize hemoglobin status by identifying and treating anemia pre-operatively. In order to identify reversible causes of anemia efficiently in this patient cohort, we implemented a reflex order for our institution’s cardiothoracic surgery center, to be ordered for patients undergoing assessment for cardiac surgery. When ordered, complete blood count (CBC) results with a hemoglobin (Hgb) of less than 13 g/dL reflex automatically to the following laboratory tests: iron profile, ferritin, vitamin B12, and reticulocyte count. Methods The purpose of our study was to investigate the impact of this reflex order over the initial 6 months of implementation. Test results and patient notes were extracted from the electronic health record and analyzed. Results Over six months, the order was placed 99 times (median Hgb 13.4 g/dL), with 36 (36%) triggering the reflex (Hgb &amp;lt; 13 g/dL). Of these 36 patients, 19 were women and 17 were men, and the cohort had a median age of 69 years. The median Hgb was 11.9 g/dL, ranging from 7.1 to 12.9 g/dL, with a median mean corpuscular volume (MCV) of 89.6 fl. The median Hgb differed by sex: 11.6 g/dL for men, 12.2 g/dL for women. Of these 36 patients, 16 had signs of iron deficiency anemia (IDA) based on laboratory results (below reference interval for iron, transferrin saturation, or ferritin), and two patients were found with vitamin B12 below the reference interval. Chart review demonstrated that 13 of the 36 patients underwent follow-up after reflex laboratory tests resulted, defined as a new diagnosis, new treatment, and/or new consult addressing the patient’s anemia. Five of these patients were given a new diagnosis of IDA, all of which were started on iron therapy. Three patients were transfused packed red blood cells prior to surgery; one was started on vitamin B12 supplementation; two had consults placed to address anemia; and two were given a new diagnosis of unspecified anemia. Conclusion Pre-operative CBC reflex testing facilitates the efficient and timely identification of reversible causes of anemia in patients undergoing diagnostic workup prior to cardiac surgery, while avoiding unnecessary panel testing in non-anemic patients.

Prognostic Impact of Anemia and Hemoglobin Levels in Unselected Patients Undergoing Coronary Angiography

Background/Objectives: This study investigates the prevalence and prognostic impact of concomitant anemia in unselected patients undergoing invasive coronary angiography (CA). The spectrum of patients undergoing CA has significantly changed during the past decades, related to ongoing demographic changes and improved treatment strategies for patients with cardiovascular disease. Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were retrospectively included at one institution. Patients with anemia (i.e., hemoglobin &lt; 13.0 g/dL for males and &lt;12.0 g/dL for females) were compared with patients without anemia (i.e., nonanemics). The primary endpoint was rehospitalization for heart failure (HF) at 36 months. Secondary endpoints comprised the risk of rehospitalization for acute myocardial infarction (AMI) and coronary revascularization. Statistical analyses included Kaplan–Meier, multivariable Cox proportional regression analyses, and propensity score matching. Results: From 2016 to 2022, 7645 patients undergoing CA were included with a median hemoglobin level of 13.2 g/dL. Anemics had a higher prevalence of coronary artery disease (CAD) (76.3% vs. 74.8%; p = 0.001), alongside an increased need for percutaneous coronary intervention (PCI) (45.3% vs. 41.5%; p = 0.001). At 36 months, the risk of rehospitalization for HF was higher in anemic patients (27.4% vs. 18.4%; p = 0.001; HR = 1.583; 95% CI 1.432–1.750; p = 0.001), which was still evident after multivariable adjustment (HR = 1.164; 95% CI 1.039–1.304; p = 0.009) and propensity score matching (HR = 1.137; 95% CI 1.006–1.286; p = 0.040). However, neither the risk of AMI (8.4% vs. 7.4%, p = 0.091) nor the risk of coronary revascularization at 36 months (8.0% vs. 8.5%, p = 0.447) was higher in anemic compared with nonanemic patients. Conclusions: In consecutive patients undergoing CA, concomitant anemia was independently associated with an increased risk of rehospitalization for HF, but not AMI or coronary revascularization. Patients with LVEF ≥ 35% and multivessel disease were especially susceptible to anemia-induced HF-related rehospitalization.

The Impact of Anemia on Long-Term Mortality in Hospitalized Patients with Exacerbation of Chronic Obstructive Pulmonary Disease.

Anemia is a risk factor for mortality within the general population and is notably prevalent among individuals with chronic obstructive pulmonary disease (COPD). Our objective was to investigate the impact of anemia on the long-term mortality risk of hospitalized COPD patients. Additionally, we aimed to identify the cause of mortality to assess whether it was different in relation to the presence of anemia. This was an observational retrospective analysis of prospectively collected data of consecutive patients admitted because of COPD exacerbation. Clinical characteristics, the presence of anemia, months of survival and cause of death if occurred, were recorded. Patients were categorized into two groups: anemic (for women hemoglobin level < 12 g/dL and for men hemoglobin level < 13 g/dL) and non-anemic. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazard regression analysis. A total of 125 patients (20% women) were included in the study. Among them, 31 (25%) were identified as anemic, By the conclusion of the study, 59 patients (47%) had died: 27 out of 31 anemic patients (87%) and 32 out of 94 non-anemic patients (34%) (p<0.001). Anemia was a robust predictor of mortality one year after admission (adjusted hazard ratio HR; 5.20 [1.86-14.55]); three years after admission (HR 4.30 [2.03-9.10]), and at the study's termination (with a follow-up period ranging from a minimum of 38 months to a maximum of 56 months) (HR; 3.80 [1.96-7.38]). Mortality in the group of patients with anemia was of 27 individuals (87%) and 32 (34%) in patients without anemia (p<0.001). The causes of mortality in patients with or without anemia were similar. The detection of anemia upon admission for COPD exacerbation serves as a robust predictor of mortality in the subsequent years.

Evaluation of Iron Deficiency Anemia in Pregnancy

Anemia in pregnancy was the common nutritional deficiency and a frequent medical concern that leads to numerous known complications, impacting both maternal and fetal health. Objective: To evaluate the biochemical parameters such as serum Iron, Ferritin TIBS and TfS in anemic and non-anemic pregnant women. Methods: In this cross-sectional study, pregnant women age 18-45 years attending the gynecological department of Niazi welfare foundation teaching hospital, Sargodha from April 2023 to January 2024 were included. Serum iron, ferritin, total iron-binding capacity, and transferrin saturation were assessed from blood samples. Independent sample t-test in SPSS version 26.0 was applied to see significant difference in biochemical parameters at value of &lt;0.05. Results: Findings revealed mean hemoglobin level of 10.26 ± 1.52 g/dl in all participants. Anemic results were found in majority, accounting for 268 (70.9%) cases. Among these anemic patients, 149 (55.5%) had mild anemia, 107 (40%) had moderate anemia, and 12 (4.5%) had severe anemia. Anemic patients had significantly lower serum ferritin level (p = 0.02), serum iron (p &lt; 0.001), and transferrin saturation (p &lt; 0.002) than non-anemic patients. Additionally, total iron-binding capacity, (p &lt; 0.001) indicated the anemic status of the pregnant women. Conclusions: Biochemical parameters of pregnant women with anemia were reduced compared to those without anemia. Healthcare providers should closely monitor pregnant women with reduced biochemical levels to prevent complications for both the mother and the fetus.

Insights on prevalence and incidence of anemia and rapid up-titration of oral heart failure treatment from the STRONG-HF study.

Anemia is one of the most frequent comorbidities in patients with heart failure (HF), which potentially can interfere with the effect of guideline-recommended HF medical therapy and can be associated with the use of neurohormonal blockers. The aim of this analysis was to determine the prevalence and changes of anemia status in the STRONG-HF study, its association with clinical endpoints, and possible interaction of the presence of anemia with the efficacy and safety of high-intensity HF treatment. The design and main results of the study have been previously described. Patients were randomized within 2days prior to anticipated hospital discharge after HF worsening in a 1:1 fashion to either high-intensity care (HIC) or usual care (UC). Baseline characteristics, clinical and safety outcomes, and treatment effect of HIC vs. UC on the primary and secondary outcomes were compared in groups based on baseline anemia. In addition, dynamics of hemoglobin during the study follow-up and predictors of incident anemia at 90days were investigated. The proportion of anemia in 1077 STRONG-HF patients at enrollment was 27.2%, while at 90days, it changed to 32.1%. The primary composite outcome occurred in 18.2% of patients without baseline anemia, and 22.5% of patients with baseline anemia (unadjusted HR 1.27; 95% CI 0.90-1.80), a difference that did not reach statistical significance. However, patients with baseline anemia had significantly less improvement of EQ-VAS questionnaire values from baseline to day 90 (adjusted LS-Mean difference -2.34 (-4.37, -0.31), P = 0.02). During the study, anemia developed in 19.4 and 14.6% in HIC and UC groups, respectively. The opposite phenomenon-recovery of anemia-occurred in 27.6 and 28.8% in HIC and UC groups (P = 0.1379). The predictors of incident anemia at 90days were male sex, geographical region other than Europe, ischemic etiology, higher glucose, and elevated uric acid at baseline. The percentages of optimal doses of renin-angiotensin system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists were not different between anemic and non-anemic patients. High-intensity care strategy did not increase rate of incident anemia at 90days and reduced the rate of primary and secondary endpoints regardless of baseline hemoglobin. Hemoglobin level and status of anemia have a dynamic nature in the acute HF patients in the post-discharge period dependent on multiple factors. High-intensity HF treatment is safe and beneficial regardless of baseline hemoglobin level and presence of anemia. The improvement of quality of life is significantly lower in anemic HF patients implying specific attention to correction of this condition.

Prognostic Role of Tissue Iron Deficiency Measured by sTfR Levels in Heart Failure Patients without Systemic Iron Deficiency or Anemia.

Background. Iron deficiency (ID) is a significant, high-prevalence comorbidity in chronic heart failure (HF) that represents an independent predictor of a worse prognosis. However, a clear-cut diagnosis of ID in HF patients is not assured. The soluble transferrin receptor (sTfR) is a marker that reflects tissue-level iron demand and may be an early marker of ID. However, the impact of sTfR levels on clinical outcomes in non-anemic HF patients with a normal systemic iron status has never been evaluated. Methods. This is a post hoc analysis of an observational, prospective cohort study of 1236 patients with chronic HF of which only those with normal hemoglobin levels and a normal systemic iron status were studied. The final cohort consisted of 215 patients. Tissue ID was defined as levels of sTfR > 75th percentile (1.65 mg/L). Our aim was to describe the association between sTfR and clinical outcomes (all-cause death and HF hospitalization) and to explore its association with a wide array of serum biomarkers. Results. The sTfR level (HR 1.48, 95% CI 1.13-1.96, p = 0.005) and tissue ID (HR 2.14, 95% CI 1.22-3.75, p = 0.008) was associated with all-cause death. However, we found no association between sTfR levels and the risk of HF hospitalization. Furthermore, high sTfR levels were associated with a worse biomarker profile indicating myocardial damage (troponin and NT-proBNP), systemic inflammation (CRP and albumin), and impaired erythropoiesis (erythropoietin). Conclusions. In this cohort, the presence of tissue ID defined by sTfR levels is an independent factor for all-cause death in patients with normal systemic iron parameters.

Preoperative anemia is a risk factor for worse 30-day outcomes in both open and endovascular repair of non-ruptured infrarenal abdominal aortic aneurysm.

Anemia is a highly prevalent condition potentially linked to chronic inflammation. Preoperative anemia is an independent risk factor across many surgical fields. However, the relationship between anemia and abdominal aortic aneurysm (AAA) repair outcomes remains unclear. This study aimed to examine the effects of preoperative anemia on 30-day outcomes of non-ruptured infrarenal AAA repair. Patients who underwent open surgical repair (OSR) and endovascular aneurysm repair (EVAR) for infrarenal AAA were identified in National Surgical Quality Improvement Program (NSQIP) targeted databases from 2012 to 2021. Anemia was defined as preoperative hematocrit less than 39% in males and 36% in females. Multivariable logistic regression was used to compare 30-day perioperative outcomes between anemic and non-anemic patients, adjusting for demographics, comorbidities, indications, aneurysm extents, operation time, and surgical approaches. There were 408 (22.13%) anemic and 1436 (77.88%) non-anemic patients who underwent OSR for non-ruptured AAA, while 3586 (25.20%) patients with and 10,644 (74.80%) without anemia underwent EVAR. In both OSR and EVAR, anemic patients had higher risks of bleeding requiring transfusion (OSR, aOR = 2.446, p < .01; EVAR, aOR = 3.691, p < .01), discharge not to home (OSR, aOR = 1.385, p = .04; EVAR, aOR = 1.27, p < .01), and 30-day readmission (OSR, aOR = 1.99, p < .01; EVAR, aOR = 1.367, p < .01). Also, anemic patients undergoing OSR had higher pulmonary events (aOR = 2.192, p < .01), sepsis (aOR = 2.352, p < .01), and venous thromboembolism (aOR = 2.913, p = .01), while in EVAR, anemic patients had higher mortality (aOR = 1.646, p = .01), cardiac complications (aOR = 1.39, p = .04), renal dysfunction (aOR = 1.658, p = .02), and unplanned reoperation (aOR = 1.322, p = .01). Moreover, in both OSR and EVAR, anemic patients had longer hospital length of stay (p < .01). In OSR and EVAR, preoperative anemia was independently associated with worse 30-day outcomes. Preoperative anemia could be a useful marker for risk stratification for patients undergoing infrarenal AAA repair.

Assessing the Burden of Anemia in Non-Communicable Diseases at a Tertiary Care Center: A Cross-Sectional Study

Background: Anemia is a prevalent global health issue, significantly affecting patients with non-communicable diseases (NCDs) like Type 2 Diabetes Mellitus (Type 2 DM), Hypertension (HTN), and Coronary Artery Disease (CAD). This study assessed the burden of anemia in patients with Type 2 DM, HTN, and CAD, and to identify its prevalence, types, and association with these chronic diseases. Methods: A cross-sectional study was carried out, involving 250 patients diagnosed with Type 2 DM, HTN, and CAD. Patients were categorized as anemic based on WHO criteria: males with Hb &lt; 13 gm% and females with Hb &lt; 12 gm%. Data were collected through a structured questionnaire. Laboratory investigations included Hb, serum creatinine, MCV, MCHC, and reticulocyte count. Statistical analysis was accomplished using chi-square tests and logistic regression to examine associations between anemia and NCDs. Results: Anemia was prevalent in 80% of the study population, with normocytic anemia being the most common type (45%). Significant correlations were found between anemia and Type 2 DM (p=0.036), HTN (p=0.032), and CAD (p=0.013). Anemic patients had significantly lower Hb levels and MCHC, and higher serum creatinine and reticulocyte counts compared to non-anemic patients. Conclusion: The study highlights a high prevalence of anemia among patients with NCDs, indicating a critical need for routine screening and integrated management of anemia in this population. Addressing anemia could improve clinical outcomes and enhance the quality of life for individuals with chronic diseases. Recommendations: Healthcare providers should implement regular anemia screening for patients with NCDs and adopt integrated care approaches that address both chronic diseases and anemia. Further research is needed to explore the underlying mechanisms linking anemia and NCDs and to develop targeted interventions. Keywords: Anemia, Non-Communicable Diseases, Type 2 Diabetes Mellitus, Hypertension, Coronary Artery Disease..

Impact of anemia on exercise capacity in patients with chronic obstructive pulmonary disease.

Objective: This study aimed to assess the impact of anaemia on exercise capacity in Chronic Obstructive Pulmonary Disease (COPD) patients by comparing the six-minute walk distance (6MWD) between anaemic and non-anaemic individuals. Study Design: Cross-sectional study. Setting: Department of Pulmonology, Khyber Teaching Hospital, Peshawar. Period: November 15, 2019 until May 14, 2020. Methods: This study included 162 COPD patients aged 40 to 70 years. Exclusion criteria encompassed any lung pathology other than COPD, malignancy, cardiac pathology, or conditions affecting hemoglobin levels. The 6MWD test was utilized to evaluate exercise capacity. Data analysis utilized SPSS Version 25.0, with descriptive statistics employed to summarize the demographic and clinical characteristics of the study population. A significance level of ≤0.05 was used to determine statistical significance. Results: The mean age of participants was 62.07 years, with a mean hemoglobin level of 12.63 gm/dl. The average 6MWD was 234.78 meters. Among the subjects, 40.74% were male. Anaemic patients had a significantly lower 6MWD (190.99 ± 95.44 meters) compared to non-anaemic patients (278.58 ± 100.17 meters; p ≤ 0.001). There were no significant differences in COPD duration, age, body mass index, or smoking status between the two groups. Conclusions: Anaemic COPD patients demonstrated a significantly reduced exercise capacity, covering approximately two-thirds of the distance non-anaemic patients did on the 6MWD test. These findings suggest that early diagnosis and management of anaemia in COPD patients could potentially improve their exercise tolerance and overall quality of life.

Prediction of anemia with thoracic computed tomography findings.

This study explored the potential of non-contrast thoracic computed tomography (CT) to predict anemia by correlating CT parameters with hemoglobin (Hb) levels in patients who underwent non-contrast thoracic CT for various indications. This retrospective study included 150 patients who underwent non-contrast thoracic CT scans and complete blood counts within 24 hours at our center between January and June 2023. Exclusion criteria included acute bleeding, iron accumulation disorders, recent transfusions, pregnancy, and certain thoracic CT artifacts. Hounsfield Unit (HU) measurements were obtained from the ascending aorta, left ventricular cavity, and descending aorta, and compared with Hb and hematocrit (Htc) values. Anemia indicators such as the 'Aortic Ring Sign (ARS)' and the 'Hyperdense Septum Sign (HSS)' were also evaluated. Anemic patients (48%) exhibited significantly lower HU measurements at all three CT scan locations and higher instances of ARS and HSS compared to non-anemic patients. Notably, the presence of HSS and ARS was strongly associated with anemia. Thresholds for HU measurements corresponding to anemia were determined using receiver operating characteristic curve analysis, which also revealed strong positive correlations between HU measurements and Hb/Htc levels. The study concludes that non-contrast thoracic CT parameters, particularly HU measurements and the presence of ARS and HSS, are significantly associated with anemia. These CT indicators could serve as reliable, non-invasive markers for predicting anemia in patients, potentially aiding in the early diagnosis and management of the condition.

Impact of Anemia on Mortality and Morbidity in Transthyretin Amyloid Cardiomyopathy

Anemia is prevalent in transthyretin amyloid cardiomyopathy (ATTR-CM), but its prognostic significance remains uncertain due to conflicting data mainly in patients not receiving disease-modifying therapy. Additionally, the effect of anemia on morbidity in this population has not been studied. This retrospective study included 270 patients diagnosed with ATTR-CM, receiving disease-modifying treatment (tafamidis), of which 30% (N=80) were anemic (defined as a hemoglobin level <13 g/dL for males and <12 g/dL for females according to the World Health Organization). At baseline, patients with anemia were on average older (mean age 79 vs. 77 years), more likely to be female (21% vs. 12%) and exhibited higher symptom severity based on NYHA class (42% in class III vs. 27%) compared to those without anemia. Additionally, they had a worse Columbia score (mean score 3 vs 5) and Columbia stage (12% in late stage vs. 7.1%) than those without anemia. Kaplan-Meier analysis indicates that anemia was associated with a higher likelihood of mortality, all-cause, and CV hospitalizations (p<0.05). However, in the Cox regression analysis, after adjusting for baseline age, ATTR genotype, and Columbia score, anemia was only associated with a higher risk of all-cause hospitalizations (HR: 1.9 (1.3-2.7), p<0.001) and CV-related hospitalizations (HR: 1.9 (1.2-2.9), p=0.006). In conclusion, this study indicates that anemic patients with ATTR-CM have higher risks of cardiovascular and all-cause hospitalizations compared to non-anemic ATTR-CM patients. Further research is needed to understand how treating anemia may improve outcomes in this high-risk patient population.

Prevalence of anemia in patients with rheumatoid arthritis and its association with dietary inflammatory index: A population-based study from NHANES 1999 to 2018.

Anemia is common in patients with rheumatoid arthritis (RA), and it is unknown whether the dietary inflammatory index (DII) is linked to anemia. This study aimed to clarify the prevalence of anemia in RA patients and its association with the DII. The data utilized in this study were collected from the National Health and Nutrition Examination Survey database from 1999 to 2018. The prevalence of anemia in RA patients was estimated by ethnicity, sex, and age. Weighted multivariate logistic regression was utilized to explore the correlation between anemia risk and DII. The most crucial dietary factors related to the risk of anemia in RA patients were screened by stepwise regression. A nomogram model was established according to key dietary factors. A total of 10.25% (confidence interval, 8.58-11.92%) of RA patients will develop anemia, with the lowest prevalence around the age of 60. In addition, higher DII levels were discovered in anemic patients than in nonanemic patients. In multivariate regression models, an important positive association was revealed between anemia and growing quartiles of DII (Q4 vs Q1: odds ratio = 1.98; confidence interval, 1.25-3.15). In the subgroup analysis, the adjusted relation of DII with anemia in females, Mexicans, smokers, nondrinkers, and age groups ≥ 60 years was statistically significant. The same association was observed in the sensitivity analysis. A nomogram model based on stepwise regression screening of key dietary factors showed good discriminatory power to identify anemic risk in RA patients (area under the curve: 0.707). In patients with RA, high DII levels were associated with the risk of anemia. More attention should be given to controlling dietary inflammation to better prevent and treat anemia.

Effects of Hypoxia and Inflammation on Hepcidin Concentration in Non-Anaemic COVID-19 Patients.

Background/Objectives: This study aimed to explore the influence of hypoxia, inflammation, and erythropoiesis on hepcidin and other iron status parameters in non-anaemic COVID-19 patients admitted to the emergency unit before the introduction of therapeutic interventions. Methods: Ninety-six COVID-19 patients and 47 healthy subjects were recruited. Patients were subdivided into hypoxic or normoxic groups and, after follow-up, into mild and moderate, severe or critical disease severity groups. Iron, unsaturated iron-binding capacity (UIBC), ferritin, C-reactive protein (CRP), and interleukin 6 (IL-6) were measured on automatic analysers. ELISA kits were used for hepcidin and erythropoietin (EPO) determination. We calculated total iron-binding capacity (TIBC) and ratios of hepcidin with parameters of iron metabolism (ferritin/hepcidin, hepcidin/iron), inflammation (hepcidin/CRP, hepcidin/IL-6), and erythropoietic activity (hepcidin/EPO). Results: Hepcidin, ferritin, EPO, CRP, IL-6, ferritin/hepcidin, and hepcidin/iron were increased, while UIBC, TIBC, hepcidin/CRP, and hepcidin/IL-6 were decreased in hypoxic compared to normoxic patients as well as in patients with severe or critical disease compared to those with mild and moderate COVID-19. Regarding predictive parameters of critical COVID-19 occurrence, in multivariable logistic regression analysis, a combination of EPO and ferritin/hepcidin showed very good diagnostic performances and correctly classified 88% of cases, with an AUC of 0.838 (0.749-0.906). Conclusions: The hypoxic signal in our group of patients was not strong enough to overcome the stimulating effect of inflammation on hepcidin expression. EPO and ferritin/hepcidin might help to identify on-admission COVID-19 patients at risk of developing a critical form of the disease.

#2264 Efficacy and safety of oral iron supplementation with liposomal iron in non-dialysis chronic kidney disease patients with iron deficiency

Abstract Background and Aims Iron deficiency (ID) is very common in patients with non-dialysis dependent chronic kidney disease (NDD-CKD). In these patients, oral iron supplementation is recommended as first-line treatment for ID. However, the efficacy of oral iron supplementation is frequently impaired by a higher incidence of adverse gastrointestinal side effects. Liposomal iron is a compound with ferric pyrophosphate enclosed in a phospholipid nucleus, providing high gastrointestinal absorption and bioavailability and a lower incidence of side effects. However, few data are available on its efficacy in patients with NDD-CKD. Method This single-arm pilot study was carried out in in patients with NDD-CKD stages 1-5 and ID, defined as serum ferritin (SF)&amp;lt;100 ng/mL and/or transferrin saturation (TSAT)&amp;lt; 20%, consecutively seen in two Nephrology units (Naples and Bari) from 01/12/2022 to 01/04/2023. We assessed the efficacy of six months of liposomal iron therapy in correcting ID across three visits after baseline (month 1, 3 and 6). All patients received liposomal iron (30 mg/day twice daily for the first month followed by 30 mg daily for the remaining five months). The primary endpoints were the achievement of SF ≥100 ng/mL and TSAT ≥20%. Secondary outcomes were hemoglobin (Hb) changes and safety of liposomal iron; adherence to the iron supplementation was assessed by monthly pill counting. Changes of continuous variables during the study were analyzed by linear mixed models assuming an unstructured covariance matrix; this was done to take into account the correlation between repeated measures and missing points for patients not completing the study. Change of prevalence of corrected SF and TSAT values from baseline to month 1, 3 and 6 was analyzed by McNemar test. Results 38 patients (65.3 ± 15.2 years, 52.6% males, 35.1% diabetes, eGFR 38.5 ± 28.8 mL/min/1.73 m2) received at least one dose of liposomal iron (safety population). Efficacy population included 34 patients with at least one control visit after baseline. Clinical characteristics of patients enrolled in the two clinics did not differ. In efficacy population, baseline SF was 44 (IQR 19-82) ng/mL and TSAT 14.3 ± 5.9%, corresponding to a percentage of SF&amp;lt;100 ng/mL of 78.9%, and TSAT&amp;lt;20% in 89.5%; 64.7% had both parameters below the cut-offs. Anemia (defined as Hb&amp;lt;12 g/dL in women and &amp;lt;13 g/dL in men) was detected in 22/34 patients. Liposomal iron induced a progressive increase of TSAT from 14.3 ± 5.9%, at baseline to 20.0 ± 7.6% at month-6 (P = 0.009) whereas no difference was detected for SF (Fig. 1A and 1C). Accordingly, at the end of study, the prevalence of TSAT&amp;gt;20% significantly increased from 11.8% to 50.0% (P = 0.002) while correction of SF, mildly improved (from 23.5% to 30.0%, P = 0.214, Fig. 1B and 1D). When patients were stratified by anemia, a significant improvement of TSAT was observed in anemic patients (from 13.3 ± 5.8% to 20.2 ± 8.1%, P = 0.012), whereas no significant improvement was found in patients without anemia (P = 0.093). Adherence to iron supplementation was 100% in patients completing the study. Hb values did not significantly increase at month-6 in either anemic (+0.60 ± 1.39 g/dL, P = 0.258) or non-anemic (+0.08 ± 0.78 g/dL, P = 1.0) patients. In safety population (n = 38), 7 patients dropped out (18.4%). In particular, treatment was discontinued in 4 patients in the first month (2 for diarrhea, 1 for dyspepsia and constipation, and 1 for death), 1 patient after 3 months (switch to intravenous iron for symptomatic anemia), and 2 after five months (1 for dyspepsia and 1 for death). Conclusion The use of liposomal iron in patients with NDD-CKD is associated with a partial correction of functional ID (TSAT&amp;lt;20%), with no significant effect on iron storage. The small sample size prevents any causative conclusion, though it may provide some insights into using these compounds in patients with CKD.