Impact of Hemoglobin Levels on Composite Cardiac Arrest or Stroke Outcome in Patients With Respiratory Failure Due to COVID-19.

Q4 Medicine
Critical care explorations Pub Date : 2024-08-22 eCollection Date: 2024-09-01 DOI:10.1097/CCE.0000000000001143
Shi Nan Feng, Thu-Lan Kelly, John F Fraser, Gianluigi Li Bassi, Jacky Suen, Akram Zaaqoq, Matthew J Griffee, Rakesh C Arora, Nicole White, Glenn Whitman, Chiara Robba, Denise Battaglini, Sung-Min Cho
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Abstract

Objectives: Anemia has been associated with an increased risk of both cardiac arrest and stroke, frequent complications of COVID-19. The effect of hemoglobin level at ICU admission on a composite outcome of cardiac arrest or stroke in an international cohort of COVID-19 patients was investigated.

Design: Retrospective analysis of prospectively collected database.

Setting: A registry of COVID-19 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with cardiac arrest or stroke up to 30 days after ICU admission. Anemia was defined as: normal (hemoglobin ≥ 12.0 g/dL for women, ≥ 13.5 g/dL for men), mild (hemoglobin 10.0-11.9 g/dL for women, 10.0-13.4 g/dL for men), moderate (hemoglobin ≥ 8.0 and < 10.0 g/dL for women and men), and severe (hemoglobin < 8.0 g/dL for women and men).

Patients: Patients older than 18 years with acute COVID-19 infection in the ICU.

Interventions: None.

Measurements and main results: Of 6926 patients (median age = 59 yr, male = 65%), 760 patients (11.0%) experienced stroke (2.0%) and/or cardiac arrest (9.4%). Cardiac arrest or stroke was more common in patients with low hemoglobin, occurring in 12.8% of patients with normal hemoglobin, 13.3% of patients with mild anemia, and 16.7% of patients with moderate/severe anemia. Time to stroke or cardiac arrest by anemia status was analyzed using Cox proportional hazards regression with death as a competing risk. Covariates selected through clinical knowledge were age, sex, comorbidities (diabetes, hypertension, obesity, and cardiac or neurologic conditions), pandemic era, country income, mechanical ventilation, and extracorporeal membrane oxygenation. Moderate/severe anemia was associated with a higher risk of cardiac arrest or stroke (hazard ratio, 1.32; 95% CI, 1.05-1.67).

Conclusions: In an international registry of ICU patients with COVID-19, moderate/severe anemia was associated with increased hazard of cardiac arrest or stroke.

血红蛋白水平对 COVID-19 导致的呼吸衰竭患者心脏骤停或中风综合预后的影响。
目的:贫血与心脏骤停和中风的风险增加有关,而心脏骤停和中风是 COVID-19 的常见并发症。本研究调查了国际 COVID-19 患者队列中 ICU 入院时血红蛋白水平对心脏骤停或中风综合结果的影响:设计:对前瞻性收集的数据库进行回顾性分析:对全球 370 多个国家和地区重症监护室收治的 COVID-19 患者进行了登记,并对重症监护室收治后 30 天内诊断为心脏骤停或中风的患者进行了回顾性分析。贫血定义为:正常(女性血红蛋白≥12.0 g/dL,男性≥13.5 g/dL)、轻度(女性血红蛋白10.0-11.9 g/dL,男性10.0-13.4 g/dL)、中度(女性和男性血红蛋白≥8.0且<10.0 g/dL)和重度(女性和男性血红蛋白<8.0 g/dL):干预措施:无:测量和主要结果在 6926 名患者(中位年龄 = 59 岁,男性 = 65%)中,760 名患者(11.0%)出现中风(2.0%)和/或心脏骤停(9.4%)。血红蛋白低的患者更容易发生心跳骤停或中风,血红蛋白正常的患者中有 12.8%、轻度贫血的患者中有 13.3%、中度/重度贫血的患者中有 16.7%。以死亡作为竞争风险,使用 Cox 比例危险回归分析了贫血状态导致中风或心脏骤停的时间。通过临床知识选择的协变量包括年龄、性别、合并症(糖尿病、高血压、肥胖、心脏或神经系统疾病)、大流行时代、国家收入、机械通气和体外膜肺氧合。中度/严重贫血与较高的心脏骤停或中风风险相关(危险比为1.32;95% CI为1.05-1.67):结论:在一项对患有 COVID-19 的 ICU 患者进行的国际登记中,中度/重度贫血与心脏骤停或中风的风险增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
0.00%
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审稿时长
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