Αρχειοθήκη ιστολογίου

Δευτέρα 17 Δεκεμβρίου 2018

Long-Term Outcomes Among Patients Discharged From the Hospital With Moderate Anemia A Retrospective Cohort Study

Background:
Randomized clinical trial findings support decreased red blood cell (RBC) transfusion and short-term tolerance of in-hospital anemia. However, long-term outcomes related to changes in transfusion practice have not been described.
Objective:
To describe the prevalence of anemia at and after hospital discharge and associated morbidity and mortality events.
Design:
Retrospective cohort study.
Setting:
Integrated health care delivery system with 21 hospitals serving 4 million members.
Participants:
445 371 surviving adults who had 801 261 hospitalizations between January 2010 and December 2014.
Measurements:
Hemoglobin levels and RBC transfusion, rehospitalization, and mortality events within 6 months of hospital discharge. Generalized estimating equations were used to examine trends over time, accounting for correlated observations and patient-level covariates.
Results:
From 2010 to 2014, the prevalence of moderate anemia (hemoglobin levels between 7 and 10 g/dL) at hospital discharge increased from 20% to 25% (P < 0.001) and RBC transfusion declined by 28% (39.8 to 28.5 RBC units per 1000 patients; P < 0.001). The proportion of patients whose moderate anemia had resolved within 6 months of hospital discharge decreased from 42% to 34% (P < 0.001), and RBC transfusion and rehospitalization within 6 months of hospital discharge decreased from 19% to 17% and 37% to 33%, respectively (P < 0.001 for both). During this period, the adjusted 6-month mortality rate decreased from 16.1% to 15.6% (P = 0.004) in patients with moderate anemia, in parallel with that of all others.
Limitation:
Possible unmeasured confounding.
Conclusion:
Anemia after hospitalization increased in parallel with decreased RBC transfusion. This increase was not accompanied by a rise in subsequent RBC use, rehospitalization, or mortality within 6 months of hospital discharge. Longitudinal analyses support the safety of practice recommendations to limit RBC transfusion and tolerate anemia during and after hospitalization.
Primary Funding Source:
National Heart, Lung, and Blood Institute.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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