Study objective: This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge.Methods: A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0-11.9 g/dL in women; 10.0-12.9 g/dL in men) and group 3 with moderately-severely reduced Hb (<10 g/dL in women and men).Results: Patients (2678; mean age 79.2 +/- 7.4 y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR = 1.62; 95% CI 1.21-2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR = 1.82; 95% CI 1.25-2.67; group 3: OR = 2.78; 95% CI 1.82-4.26) and discharge (group 2: OR = 2.37; 95% CI 1.48-3.93; group 3: OR = 3.70; 95% CI 2.14-6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes.Conclusions: Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients

Maura Marcucci;Domenico Prisco;Elmo Mannarino;Graziana Lupattelli;Vanessa Bianconi;Francesco Paciullo;Oliviero Olivieri;Maria Valenti;Maria Domenica Cappellini;Lucia Sofia;Maria Carbone;Giancarlo Agnelli;Emanuela Marchesini;Elisabetta Greco;Marco Bertolotti;Andrea Miceli;Elisa Pellegrini;Mauro Serra;Roberto Leonardi;Giorgio Minelli;Massimo Mattioli;Marco Cattaneo;Maria Valentina Amoruso;
2017-01-01

Abstract

Study objective: This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge.Methods: A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0-11.9 g/dL in women; 10.0-12.9 g/dL in men) and group 3 with moderately-severely reduced Hb (<10 g/dL in women and men).Results: Patients (2678; mean age 79.2 +/- 7.4 y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR = 1.62; 95% CI 1.21-2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR = 1.82; 95% CI 1.25-2.67; group 3: OR = 2.78; 95% CI 1.82-4.26) and discharge (group 2: OR = 2.37; 95% CI 1.48-3.93; group 3: OR = 3.70; 95% CI 2.14-6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes.Conclusions: Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11391/1538513
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