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Thevenin M, Putot S, Manckoundia P, Putot A. Transfusion in Older Anemic Patients: Should the Troponin Value Be Taken into Account? Am J Med 2022; 135:1008-1015.e1. [PMID: 35469733 DOI: 10.1016/j.amjmed.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anemia is common in older individuals, but it is not known whether the prognostic impact of transfusion differs according to cardiac troponin concentration. METHODS During this 2-year retrospective study in an acute geriatric unit, 514 patients with hemoglobin <10 g/dL and troponin sampling were included. Thirty-day and 1-year mortality were compared according to transfusion status and troponin and hemoglobin levels. RESULTS Of the 514 anemic patients included (median age 88 years), 157 (31%) had elevated troponin concentrations. These patients were more likely to die at 30 days (49% vs 27%, P < .001) and 1 year (65% vs 51%, P = .004) than patients with normal values. Among patients with elevated troponin concentrations, 30-day mortality tended to be lower in transfused than in not-transfused patients (hazard ratio 0.48; 95% confidence interval, 0.21-1.08; P = .07). This association was not found in patients without troponin elevation (hazard ratio 1.09; 95% CI, 0.61-1.93; P = .8). Transfusion was associated with 30-day survival in patients with hemoglobin ≤8 g/dL. It was also associated with excess 1-year mortality in patients with hemoglobin >8 g/dL. CONCLUSIONS This pilot study suggests that transfusion could be associated with better 30-day outcomes in older anemic patients with anemia-related myocardial injury. Thus, troponin levels could be involved in decision-making relative to transfusion in anemic older patients. Clinical trials are needed to establish the benefit of transfusion in patients with elevated troponins.
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Affiliation(s)
- Manon Thevenin
- Acute Geriatric Unit, Dijon University Hospital, Dijon, France
| | - Sophie Putot
- Acute Geriatric Unit, La Réunion University Hospital, Saint Pierre, La Réunion, France
| | | | - Alain Putot
- Acute Geriatric Unit, La Réunion University Hospital, Saint Pierre, La Réunion, France; Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), University of Burgundy, Dijon, France.
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2
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Çamci S, Kinik M, Ari S, Ari H, Melek M, Bozat T. The predictive value of hemoglobin to creatinine ratio for contrast-induced nephropathy in percutaneous coronary interventions. Clin Chem Lab Med 2022; 60:1455-1462. [PMID: 35727209 DOI: 10.1515/cclm-2022-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hemoglobin and creatinine levels are important factors for contrast induced nephropathy (CIN) development. Our aim in this study is to investigate the predictive value of hemoglobin to creatinine ratio for CIN development in patients with percutaneous coronary intervention (PCI). METHODS A total of 500 patients who underwent PCI in our clinic were evaluated prospectively in terms of CIN. Hemoglobin to creatinine ratio is calculated as baseline hemoglobin/baseline serum creatinine value. glomerular filtration rate (GFR) was calculated with Cockcroft-Gault formula. The definition of CIN includes absolute (≥0.5 mg/dL) or relative increase (≥25%) in serum creatinine at 48-72 h after exposure to a contrast agent compared to baseline serum creatinine values. RESULTS CIN was detected in 13.8% (69 patients) of 500 patients. In multivariate lineer regression analysis, hemoglobin to creatinine ratio (beta: -0.227, p=0.03) and ejection fraction (EF) (beta: -0.161, p<0.001), contrast amount used (beta: 0.231, p<0.001) were found to be significant predictors for the development of CIN. In receiver operating characteristics (ROC) analysis; AUC=0.730 (0.66-0.79) for hemoglobin to creatinine ratio, p<0.001, AUC=0.694 (0.62-0.76) for EF, p<0.001 and AUC=0.731 (0.67-0.78) for contrast amount used p<0.001. CONCLUSIONS Hemoglobin to creatinine ratio, EF and contrast amount used were independent predictors for CIN development in patients with PCI (NCT04703049).
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Affiliation(s)
- Sencer Çamci
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Mustafa Kinik
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Selma Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Hasan Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Mehmet Melek
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Tahsin Bozat
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
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3
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Nichols L, Bridgewater JC, Wagner NB. Ascariasis, trichuriasis and fatal non-transfusion. AUTOPSY AND CASE REPORTS 2021; 11:e2021314. [PMID: 34458182 PMCID: PMC8387076 DOI: 10.4322/acr.2021.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Blood transfusion for chronic anemia can lead to acute or decompensated heart failure in patients who have fluid overload as part of their compensatory response and/or have intrinsic heart disease, and then it could be fatal in such clinical scenarios. This is the report of a case of profound chronic anemia in a young male patient, who was not transfused and then developed confusion followed by terminal cardiopulmonary arrest. Autopsy revealed severe trichuriasis to be the cause of the anemia, along with severe ascariasis, but minimal intrinsic brain disease. This supports the conclusion that anemia was the cause of the confusion, and the lesson that confusion may be a sign that the benefit of blood transfusion outweighs the risk in a patient with severe chronic anemia.
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Affiliation(s)
- Larry Nichols
- Mercer University School of Medicine, Department of Pathology and Clinical Science Education, Macon, GA, USA
| | - Joshua Curtis Bridgewater
- Mercer University School of Medicine, Department of Pathology and Clinical Science Education, Macon, GA, USA
| | - Nicholas Brennan Wagner
- Mercer University School of Medicine, Department of Pathology and Clinical Science Education, Macon, GA, USA
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4
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Al-Riyami AZ, Baskaran B, Panchatcharam SM, Al-Sabti H. Preoperative Anemia is Associated with Increased Intraoperative Mortality in Patients Undergoing Cardiac Surgery. Oman Med J 2021; 36:e267. [PMID: 34164157 PMCID: PMC8200659 DOI: 10.5001/omj.2021.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/21/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives We sought to investigate the incidence of preoperative anemia in cardiac surgery and its association with outcomes. Methods A retrospective review of clinical, laboratory, and transfusion data for all patients who underwent cardiac surgery at Sultan Qaboos University Hospital between 2008 and 2014 was performed. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin levels < 13 g/dL (males) and < 12 g/dL (females). Clinical variables were compared using chi-square and independent t-test. Factors influencing preoperative mortality were analyzed using multivariate binary logistics regression. Results A total of 599 patients (69.9% males and 30.1% females) were included in the study; 69.3% underwent coronary artery bypass surgery. Preoperative anemia was found in 76.1% of females and 26.7% of male patients. Rates of intraoperative red blood cell transfusions were higher among anemic patients (75.9% vs. 52.3%, p < 0.001). Anemic patients had a worse risk profile with higher incidence of diabetes mellitus (53.8% vs. 38.9%, p < 0.001), congestive heart failure (51.4% vs. 28.3%, p < 0.001), arrhythmia (16.5% vs. 8.6%, p = 0.004), and cerebrovascular disease (10.0% vs. 4.9%, p = 0.015). In addition, they had a higher risk of overall mortality (6.4% vs. 2.6%, p = 0.023). Preoperative anemia remained a risk factor for intraoperative mortality after logistic regression (odds ratio = 4.08, 95% confidence interval: 1.43–11.66; p = 0.009). Conclusions Preoperative anemia in cardiac surgery is independently associated with increased intraoperative mortality and early readmission rates post-surgery.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Balan Baskaran
- Department of Surgery, Division of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sathiya M Panchatcharam
- Research Section, Medical Simulation and Skills Development Centre, Oman Medical Specialty Board, Muscat, Oman
| | - Hilal Al-Sabti
- Department of Surgery, Division of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, Oman.,Oman Medical Specialty Board, Muscat, Oman
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5
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Okyay K, Sadıç BÖ, Şahinarslan A, Durakoğlugil ME, Karabay CY, Eryüksel SE, Gülbahar Ö, Tekin A, Yıldırır A, Görenek B, Yavuzgil O, Fak AS. Turkish Society of Cardiology consensus paper on the rational use of cardiac troponins in daily practice. Anatol J Cardiol 2019; 21:331-344. [PMID: 31073114 PMCID: PMC6683230 DOI: 10.14744/anatoljcardiol.2019.42247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 01/23/2023] Open
Affiliation(s)
- Kaan Okyay
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey.
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6
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Al-Riyami AZ, Al-Khabori M, Baskaran B, Al-Lawati H, Mukaddirov M, Al-Sabti HA. Impact of Blood Transfusion on Troponin I Levels and Outcomes after Cardiac Surgery: A Cohort Study. Oman Med J 2019; 34:14-19. [PMID: 30671179 PMCID: PMC6330194 DOI: 10.5001/omj.2019.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives Increased cardiac troponin I (TI) has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective cardiac surgeries. Methods We conducted a retrospective review of 542 patients. Patients were divided into two groups based on TI levels at 24 hours (TI24) (> 6.5 µg/L vs. ≤ 6.5 µg/L). The impact of transfusion on TI levels was estimated using logistic regression and adjusted for using a multivariable model that included aortic cross-clamp time and preoperative ejection fraction. The effect of TI on the clinical outcomes was examined. Results Red blood cell (RBC) transfusion was found to be associated with high TI levels (odds ratio (OR) = 2.33, p = 0.007, 95% confidence interval (CI): 1.30–4.30). A trend was observed when aortic cross-clamp time and preoperative ejection fraction were adjusted for (OR = 2.06, p = 0.080, 95% CI: 0.90–4.70). An association was found between aortic cross-clamp time and high TI levels in the multivariable model (OR = 1.01, p = 0.028, 95% CI: 1.00–1.02). Elevated TI levels was associated with higher mortality (OR = 4.15, p = 0.017, 95% CI: 1.29–13.08), renal failure (OR = 2.99, p = 0.004, 95% CI: 1.41–6.32), and increased length of stay in-hospital (OR = 4.50, p = 0.020, 95% CI: 0.69–8.30). Conclusions RBC transfusion is associated with increased TI24 post-cardiac surgery and worse outcomes, albeit a confounding effect cannot be excluded. Larger studies are required to confirm these findings.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Balan Baskaran
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Hilal A Al-Sabti
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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7
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Putot A, Zeller M, Perrin S, Beer JC, Ravisy J, Guenancia C, Robert R, Manckoundia P, Cottin Y. Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey. Am J Med 2018; 131:422-429.e4. [PMID: 29030059 DOI: 10.1016/j.amjmed.2017.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir. METHODS We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (≤8, >8 to ≤10, and >10 g/dL) and age (<80 or ≥80 years). RESULTS A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respectively (P < .001). In Cox regression analysis, transfusion was associated with increased 1-year mortality for hemoglobin nadir >10 g/dL but no significant effect for hemoglobin nadir between 8 and 10 g/dL. When hemoglobin nadir was ≤8 g/dL, transfusion did not influence 1-year mortality for younger patients (65-79 years). However, for older patients (≥80 years), transfusion was associated with lower mortality (hazard ratio 0.43 [95% confidence interval, 0.22-0.86], P = .016). CONCLUSION Among older patients with acute myocardial infarction, the effect of transfusion was largely dependent on hemoglobin threshold and age. Transfusion was associated with increased 1-year mortality when hemoglobin nadir was >10 g/dL. However, in patients aged ≥80 years with hemoglobin nadir <8 g/dL, transfusion was associated with a 50% reduction in 1-year mortality.
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Affiliation(s)
- Alain Putot
- Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France
| | - Marianne Zeller
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne Franche-Comté, Dijon, France.
| | - Sophie Perrin
- Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France
| | - Jean-Claude Beer
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Jack Ravisy
- Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France
| | - Charles Guenancia
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Raphaël Robert
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Patrick Manckoundia
- Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France; Institut National de la Santé et de la Recherche Médicale U1093 Cognition Action Plasticité, Université de Bourgogne Franche-Comté, Dijon, France
| | - Yves Cottin
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne Franche-Comté, Dijon, France; Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
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8
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Colombo MG, Kirchberger I, Amann U, Heier M, Thilo C, Kuch B, Peters A, Meisinger C. Association between admission anemia and long-term mortality in patients with acute myocardial infarction: results from the MONICA/KORA myocardial infarction registry. BMC Cardiovasc Disord 2018. [PMID: 29523073 PMCID: PMC5845173 DOI: 10.1186/s12872-018-0785-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Previous studies have shown that the presence of anemia is associated with increased short- and long-term outcomes in patients with acute myocardial infarction (AMI). This study aims at examining the impact of admission anemia on long-term, all-cause mortality following AMI in patients recruited from a population-based registry. Contrary to most prior studies, we distinguished between patients with mild and moderate to severe anemia. METHODS This prospective study was conducted in 2011 patients consecutively hospitalized for AMI that occurred between January 2005 and December 2008. Patients who survived more than 28 days after AMI were followed up until December 2011. Hemoglobin (Hb) concentration was measured at hospital admission and classified according to the World Health Organization (WHO). Mild anemia was defined as Hb concentration of 11 to < 12 g/dL in women and 11 to < 13 g/dL in men; moderate to severe anemia as Hb concentration of < 11 g/dL. Adjusted Cox regression models were calculated to compare survival in patients with and without anemia. RESULTS Mild anemia and moderate to severe anemia was found in 183 (9.1%) and 100 (5%) patients, respectively. All-cause mortality after a median follow-up time of 4.2 years was 11.9%. The Cox regression analysis showed significantly increased mortality risks in both patients with mild (HR 1.74, 95% CI 1.23-2.45) and moderate to severe anemia (HR 2.05, 95% CI 1.37-3.05) compared to patients without anemia. CONCLUSION This study shows that anemia adversely affects long-term survival following AMI. However, further studies are needed to confirm that anemia can solely explain worse long-term outcomes after AMI.
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Affiliation(s)
- Miriam Giovanna Colombo
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany. .,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
| | - Inge Kirchberger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
| | - Ute Amann
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
| | - Margit Heier
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christian Thilo
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany.,Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
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9
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Rahimi-Levene N, Koren-Michowitz M, Zeidenstein R, Peer V, Golik A, Ziv-Baran T. Lower hemoglobin transfusion trigger is associated with higher mortality in patients hospitalized with pneumonia. Medicine (Baltimore) 2018; 97:e0192. [PMID: 29561440 PMCID: PMC5895359 DOI: 10.1097/md.0000000000010192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Patients hospitalized with pneumonia may require packed red blood cell (RBC) transfusion during their hospital stay. Patient survival may be associated with the transfusion trigger. These patients may need a higher hemoglobin (Hb) trigger than that suggested by the AABB guidelines (7 g/dL).The objective of this study was to evaluate the association between the initial transfusion Hb trigger and in-hospital mortality.A historical cohort study of all patients hospitalized in an internal medicine ward between 2009 and 2014 with pneumonia, who received at least 1 unit of RBC, was evaluated. The primary outcome was all-cause in-hospital mortality.One hundred males and 77 females with a median age of 80 (interquartile range 71-87) years were included. The median Hb trigger was 8.10 g/dL. Mortality rate was 56% in patients with Hb trigger ≤7 g/dL, 43.8% in Hb trigger 7 to 8 g/dL, and 29.5% in Hb trigger >8 g/dL (P = .045). Patients in the 3 Hb trigger categories did not differ in age, sex, comorbidities, albumin, creatinine, C-reactive protein, white blood cells, and platelet counts. The result of a multivariate analysis showed that only lower Hb trigger (odds ratio [OR]≤ 7vs.>8 = 5.24, OR7-8vs.>8 = 2.13, P = .035) and higher neutrophil count (P = .012) were associated with increased in-hospital mortality.In conclusion, a lower transfusion trigger is associated with increased risk for in-hospital mortality in patients hospitalized with pneumonia requiring RBC transfusion.
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Affiliation(s)
- Naomi Rahimi-Levene
- Blood Bank, Assaf Harofeh Medical Center, Zerifin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Hematology Institute
| | | | - Ronit Zeidenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Internal Medicine Department “A”, Assaf Harofeh Medical Center, Zerifin
| | | | - Ahuva Golik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Internal Medicine Department “A”, Assaf Harofeh Medical Center, Zerifin
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Honda Y, Watanabe T, Otaki Y, Tamura H, Nishiyama S, Takahashi H, Arimoto T, Shishido T, Miyamoto T, Shibata Y, Konta T, Kawasaki R, Daimon M, Ueno Y, Kato T, Kayama T, Kubota I. Gender differences in the impact of anemia on subclinical myocardial damage and cardiovascular mortality in the general population: The Yamagata (Takahata) study. Int J Cardiol 2018; 252:207-212. [DOI: 10.1016/j.ijcard.2017.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/27/2017] [Accepted: 11/07/2017] [Indexed: 11/17/2022]
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11
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Erratum: Avoidance of Blood Transfusion to Patients Suffering From Myocardial Injury and Severe Anemia Is Associated With Increased Long-Term Mortality: Erratum. Medicine (Baltimore) 2016; 95:e8980. [PMID: 31265655 PMCID: PMC5079346 DOI: 10.1097/01.md.0000504795.30089.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
[This corrects the article DOI: 10.1097/MD.0000000000001635.].
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12
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Xu J, Zhang M, Ni Y, Shi J, Gao R, Wang F, Dong Z, Zhu L, Liu Y, Xu H. Impact of low hemoglobin on the development of contrast-induced nephropathy: A retrospective cohort study. Exp Ther Med 2016; 12:603-610. [PMID: 27446250 PMCID: PMC4950745 DOI: 10.3892/etm.2016.3416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 03/31/2016] [Indexed: 12/21/2022] Open
Abstract
An increase in the use of iodinated contrast media, such as iohexol, iodixanol, iopamidol and iopromide, occasionally causes contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). The present study aimed to assess the effects of low levels of hemoglobin on the development of CIN in patients with normal renal function following CAG/PCI. A total of 841 consecutive patients undergoing CAG/PCI were divided into two groups: Patients with low levels of hemoglobin (male, <120 g/l; female, <110 g/l; n=156) and normal levels of hemoglobin (male, 120-160 g/l; female, 110-150 g/l; n=685). Multiple logistic regression analysis was performed to identify risk factors for CIN, which developed in 14.7% of patients with low levels of hemoglobin (relative risk, 3.07) and 5% of patients with normal levels of hemoglobin (P<0.01). Independent risk factors for developing CIN in patients with low levels of hemoglobin were a contrast media volume ≥200 ml, diuretic usage, low levels of hemoglobin and diabetes mellitus. For the patients with normal hemoglobin levels, the independent risk factors for developing CIN were a contrast media volume ≥200 ml and diuretic usage. The change in serum creatinine in patients with low levels of hemoglobin was significantly greater compared with patients with normal levels of hemoglobin (7.35±22.60 vs. 1.40±12.00; P<0.01). A similar incidence of developing CIN was observed when patients were administered each type of contrast media: Iohexol, iodixanol, iopamidol and iopromide. The optimal cut-off point at which the serum hemoglobin concentration resulted in a high probability of developing CIN was determined as 111.5 g/l in females and 115.5 g/l in males. In conclusion, low levels of hemoglobin were observed to be an independent risk factor for developing CIN. Patients with reduced hemoglobin levels should, therefore, be closely monitored prior to, and during, the administration of iodinated contrast media.
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Affiliation(s)
- Jinzhong Xu
- Department of Clinical Pharmacy, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Meiling Zhang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Yinghua Ni
- Department of Clinical Pharmacy, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310052, P.R. China
| | - Jiana Shi
- Department of Pharmacy, Zhejiang Province People's Hospital, Hangzhou, Zhejiang 31014, P.R. China
| | - Ranran Gao
- Department of Cardiovascular Medicine, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, P.R. China
| | - Zhibing Dong
- Department of Cardiovascular Medicine, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
| | - Lingjun Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yanlong Liu
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Huimin Xu
- Department of Clinical Pharmacy, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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