Impact of hemoglobin levels on composite cardiac arrest or stroke outcome in patients with respiratory failure due to COVID-19
Date
2024
Authors
Feng, S.N.
Kelly, T.L.
Fraser, J.F.
Li Bassi, G.
Suen, J.
Zaaqoq, A.
Griffee, M.J.
Arora, R.C.
White, N.
Whitman, G.
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Journal article
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Critical Care Explorations, 2024; 6(9, article no.e1143):1-12
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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).
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.
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Copyright 2024 The author(s) (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Access Condition Notes: This is an open-access article