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Šarić Jadrijev A, Bego A, Lojpur B, Poljak D, Žaja M, Matas J, Pivalica B, Stojanović Stipić S, Čapkun V, Vukojević K, Glavina Durdov M, Bratanić A. Admission Hemoglobin Associated with Increased Mortality in Hip Fracture Surgical Patients: An Observational Study. Biomedicines 2024; 12:2041. [PMID: 39335554 PMCID: PMC11428683 DOI: 10.3390/biomedicines12092041] [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: 07/26/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
In hip fracture patients, who are mostly elderly, preexisting anemia can be worsened when combined with trauma and surgery. To this date, there is no unequivocal approach about transfusion thresholds. We analyzed hemoglobin (Hb) and hematocrit (Hct) levels at three time points in surgical patients with proximal femoral fractures (PFF) to see which levels were triggers for transfusions and whether transfusions were related to mortality after hospital discharge. A total of 956 patients were operated on from 1 January 2021 to 31 December 2022 at the University Hospital of Split and included in the study. There were more women (74%); 47% patients had admission Hb < 120 g/L. Transfusion was given preoperatively to 88, intraoperatively to 74 and postoperatively to 309 patients. Transfusion thresholds were as follows: Hb 84 g/L preoperatively, 99 intraoperatively and 83 postoperatively. After hospital discharge, 10.79% of patients died within the 1st month and 23% within 6 months. In the group of non-survivors, 60% of patients had admission Hb ≤ 117 g/L and the proportion of patients transfused preoperatively was two times higher. Preoperative transfusion thresholds could be set to higher levels for patients with surgically treated PFF. However, that could increase mortality even more. Further investigation is necessary.
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Affiliation(s)
- Ana Šarić Jadrijev
- Department of Anaesthesiology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - Ana Bego
- Department of Anaesthesiology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - Borna Lojpur
- Institute of Emergency Medicine in Split-Dalmatia County, Spinčićeva 1, 21000 Split, Croatia
| | - Dino Poljak
- Department of Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - Marija Žaja
- Department of Anaesthesiology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - Jakov Matas
- Priska Med Polyclinic, Kroz Smrdečac 45, 21000 Split, Croatia
| | - Božen Pivalica
- Department of Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - Sanda Stojanović Stipić
- Department of Anaesthesiology and Intensive Care, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - Vesna Čapkun
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Šoltanska 2A, 21000 Split, Croatia
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Šoltanska 2A, 21000 Split, Croatia
| | - Merica Glavina Durdov
- Department of Pathology, Legal Medicine and Cytology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - Andre Bratanić
- Department of Internal Medicine, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
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Ueyama H, Yamamura M, Koyanagi J, Fukunaga K, Takemura S, Nakamura S. Early Postoperative Functional Recovery in Older Patients With Periprosthetic Femoral Fractures: Comparison Between Cemented and Cementless Stem Revisions. Arthroplast Today 2024; 28:101467. [PMID: 39100417 PMCID: PMC11295462 DOI: 10.1016/j.artd.2024.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background Early postoperative functional recovery is important in older patients with lower-extremity fractures to prevent disuse, and periprosthetic femoral fractures (PFFs) are no exception. This study aimed to compare the postoperative functional recovery in the early phase after revision for PFF with loose stems between cemented and cementless stems. Methods Eighteen patients with Unified Classification System type B2 PFF were included in this retrospective cohort study with a follow-up period of about 2 years. All patients underwent stem revision and were divided into 2 groups: the cemented stem group (n = 9) and the cementless stem group (n = 9). In postrevision, functional independence measure score, independent walk rate, activities of daily living recovery rate to the original level at 2 weeks postoperatively, the Beals and Tower classification for radiological status, and survival rate for readmission as endpoints were compared between the 2 groups. Results Patients in the cemented group recovered functional mobility earlier than in the cementless group, with higher postoperative functional independence measure functional subscale values (73 vs 50 points, P = .02), higher independent walk rate (89 vs 11%, P < .01), and more postoperative activities of daily living recovery (100% vs 44%, P = .03) at 2 weeks postoperatively. The Beals and Tower classification and survival rates were similar in both groups. Conclusions Revision using a cemented stem for PFF in older patients was a useful surgical procedure in terms of early postoperative functional recovery. Cemented stem revision was comparable with cementless in bone union and safety at 2 years postoperatively.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Mitsuyoshi Yamamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Kenji Fukunaga
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Sano Memorial Hospital, Izumisanoshi, Osaka, Japan
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Jia W, Wang S, Yang S, Zhao Y, Zhu Q, Ning C, Chen Y, Fu S, Chen Y, He Y, Liu M. Association of anemia with all-cause mortality in Chinese centenarians: a prospective cohort study. J Nutr Health Aging 2024; 28:100248. [PMID: 38669839 DOI: 10.1016/j.jnha.2024.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES This study aimed to examine the relationship between anemia and all-cause mortality in Chinese centenarians. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS We included 1002 Chinese centenarians from the China Hainan Centenarian Cohort Study (CHCCS) MEASUREMENTS: Standard procedures were followed to perform blood analysis, home interviews, and physical examinations. Anemia was defined as a hemoglobin level of less than 130 g/L for men and less than 120 g/L for women. RESULTS During the 9-year follow-up period, a total of 929 (92.7%) deaths were identified. Cox proportional hazards regression models revealed that anemia (hazard ratio [HR] 1.289, 95% confidence interval [CI]: 1.117-1.489) was significantly associated with all-cause mortality. There was an apparent dose-response relationship between anemia and all-cause mortality. Centenarians with severe anemia had approximately 1.6 times higher likelihood of all-cause mortality than those without anemia (HR 1.662; 95% CI: 1.154-2.394). CONCLUSION Anemia is associated with an increased risk of all-cause mortality in Chinese centenarians. Further research will be needed to collect more comprehensive data on the etiology of anemia and causes of death in centenarians.
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Affiliation(s)
- Wangping Jia
- Department of Wound Infection and Drug, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Diseases, Second Medical Center, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Shanshan Yang
- Department of Disease Prevention and Control, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya 572013, China
| | - Qiao Zhu
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya 572013, China
| | - Chaoxue Ning
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya 572013, China
| | - Yujian Chen
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya 572013, China
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya 572013, China
| | - Yizhi Chen
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, Academician Chen Xiangmei of Hainan Province Kidney Diseases Research Team Innovation Center, Sanya 572013, China; Senior Department of Nephrology, The First Medical Center of Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing 100853, China
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Diseases, Second Medical Center, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Miao Liu
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Diseases, Second Medical Center, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, Beijing 100853, China; Department of Anti-NBC Medicine, Graduate School, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
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Leoni S, Ferraresi M, Motta I, Hu C, Fracanzani AL, Barcellini W, Fattizzo B. Deciphering cytopenias in internal medicine: a single-center observational study. Intern Emerg Med 2024; 19:661-668. [PMID: 38270774 PMCID: PMC11039542 DOI: 10.1007/s11739-023-03517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
Cytopenia is a common finding in patients admitted to internal medicine wards and the clinical workup may be long and time-consuming. In this single-center observational study, we analyzed a series of 151 inpatients who received hematologist referral due to cytopenia observed during hospital admission. Patients were mainly elderly (median 71 years, 15-96) and 87% had at least one comorbidity. Anemia was the most common cytopenia (91%), followed by thrombocytopenia (51%), and neutropenia (22%); 73 (48%) patients had a bicytopenia and 5 (3%) pancytopenia. Cytopenias were mainly severe, 66% of cases required RBC transfusions, and 21% platelet pools. During a median hospital stay of 15 days (1-166), 53 subjects (35%) received a hematologic discharge diagnosis, whilst the two-thirds had secondary cytopenia mainly due to associated comorbidities. Only about 34% of 2,728 diagnostic tests performed (including laboratory, imaging, and histology) clearly informed the discharge diagnosis in this heterogenous setting. Specifically, bone-marrow evaluation indicated in 46 (30%) patients, was diagnostic in 32 (69.6%). Eleven percent of patients died due to progression of the oncohematologic disease (29%), sepsis (24%), and solid tumor progression (24%). In conclusion, cytopenias in the internal medicine setting are mainly severe, more frequently secondary to associated comorbidities (2/3 of patients) and deserve proper workup before second/third-level tests (immune-hematological assays and CT scan or PET and bone-marrow evaluation, respectively).
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Affiliation(s)
- Simona Leoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
- University of Milan, Milan, Italy
| | - Marta Ferraresi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
- University of Milan, Milan, Italy
| | - Irene Motta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Cinzia Hu
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
| | - Anna Ludovica Fracanzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
- University of Milan, Milan, Italy
| | - Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
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Li MM, Miles S, Callum J, Lin Y, Karkouti K, Bartoszko J. Postoperative anemia in cardiac surgery patients: a narrative review. Can J Anaesth 2024; 71:408-421. [PMID: 38017198 DOI: 10.1007/s12630-023-02650-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Anemia reduces the blood's ability to carry and deliver oxygen. Following cardiac surgery, anemia is very common and affects up to 90% of patients. Nevertheless, there is a paucity of data examining the prognostic value of postoperative anemia. In this narrative review, we present findings from the relevant literature on postoperative anemia in cardiac surgery patients, focusing on the incidence, risk factors, and prognostic value of postoperative anemia. We also explore the potential utility of postoperative anemia as a therapeutic target to improve clinical outcomes. SOURCE We conducted a targeted search of MEDLINE, Embase, and the Cochrane Database of Systematic Reviews up to September 2022, using a combination of search terms including postoperative (post-operative), perioperative (peri-operative), anemia (anaemia), and cardiac surgery. PRINCIPAL FINDINGS The reported incidence of postoperative anemia varied from 29% to 94% across the studies, likely because of variations in patient inclusion criteria and classification of postoperative anemia. Nonetheless, the weight of the evidence suggests that postoperative anemia is common and is an independent risk factor for adverse postoperative outcomes such as acute kidney injury, stroke, mortality, and functional outcomes. CONCLUSIONS In cardiac surgery patients, postoperative anemia is a common and prognostically important risk factor for postoperative morbidity and mortality. Nevertheless, there is a lack of data on whether active management of postoperative anemia is feasible or effective in improving patient outcomes.
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Affiliation(s)
- Michelle M Li
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Jeannie Callum
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - Yulia Lin
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Justyna Bartoszko
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada.
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada.
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Arai H, Nozoe M, Kamiya K, Matsumoto S, Morimoto T. Anemia and Rehabilitation Outcomes in Patients Undergoing Convalescent Rehabilitation. Arch Phys Med Rehabil 2024; 105:539-545. [PMID: 37981255 DOI: 10.1016/j.apmr.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Assessment of the association between anemia and recovery of physical disability in patients with functional impairment. DESIGN A retrospective cohort study. SETTING A convalescent rehabilitation ward. PARTICIPANTS The subjects were patients undergoing convalescent rehabilitation due to neurologic disease, musculoskeletal disorders, or hospital-associated deconditioning. Patients were classified into 3 groups (no anemia; mild anemia [men: hemoglobin of 11.0-12.9 g/dL; women: hemoglobin of 11.0-11.9 g/dL]; and moderate/severe anemia [hemoglobin < 11.0 g/dL]) based on hemoglobin levels. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The study outcomes were functional independence measures for motor function (FIM-M) score at discharge, changes in the FIM-M score between hospital admission and discharge, length of stay, and FIM-M efficiency score (change in FIM-M score divided by length of stay). A linear regression model was constructed to explore the association of anemia with the FIM-M efficiency score. As a subgroup analysis, we constructed a linear regression model to explore the association of anemia with the FIM-M efficiency score in patients with or without stroke. RESULTS Of 376 consecutive patients with a mean age of 80 years, 258 (69%) had mild or moderate/severe anemia. There were no significant differences between the 3 groups in the FIM-M score at discharge, changes in the FIM-M score, length of stay, and FIM-M efficiency score. A multiple linear regression model showed that the FIM-M efficiency score was not associated with anemia (mild anemia group: β=-0.02, P=.8; moderate/severe anemia group: β=-0.005, P=.9). In the subgroup analysis of patients with or without stroke, the multiple regression model also showed no significant association between anemia and FIM-M efficiency score in each group. CONCLUSIONS Anemia on admission was common among patients in a convalescent rehabilitation ward but was not associated with improvement of FIM-M after rehabilitation.
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Affiliation(s)
- Hideki Arai
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Toyonaka Heisei Hospital, Toyonaka, Japan.
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Kuniyasu Kamiya
- Department of Basic Medical Sciences Region, Kobe City College of Nursing, Kobe, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
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Hao Y, Zhang J, Yu J, Yu Z, Yang L, Hao X, Gao F, Zhou C. Predicting quetiapine dose in patients with depression using machine learning techniques based on real-world evidence. Ann Gen Psychiatry 2024; 23:5. [PMID: 38184628 PMCID: PMC10771703 DOI: 10.1186/s12991-023-00483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/25/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Being one of the most widespread, pervasive, and troublesome illnesses in the world, depression causes dysfunction in various spheres of individual and social life. Regrettably, despite obtaining evidence-based antidepressant medication, up to 70% of people are going to continue to experience troublesome symptoms. Quetiapine, as one of the most commonly prescribed antipsychotic medication worldwide, has been reported as an effective augmentation strategy to antidepressants. The right quetiapine dose and personalized quetiapine treatment are frequently challenging for clinicians. This study aimed to identify important influencing variables for quetiapine dose by maximizing the use of data from real world, and develop a predictive model of quetiapine dose through machine learning techniques to support selections for treatment regimens. METHODS The study comprised 308 depressed patients who were medicated with quetiapine and hospitalized in the First Hospital of Hebei Medical University, from November 1, 2019, to August 31, 2022. To identify the important variables influencing the dose of quetiapine, a univariate analysis was applied. The prediction abilities of nine machine learning models (XGBoost, LightGBM, RF, GBDT, SVM, LR, ANN, DT) were compared. Algorithm with the optimal model performance was chosen to develop the prediction model. RESULTS Four predictors were selected from 38 variables by the univariate analysis (p < 0.05), including quetiapine TDM value, age, mean corpuscular hemoglobin concentration, and total bile acid. Ultimately, the XGBoost algorithm was used to create a prediction model for quetiapine dose that had the greatest predictive performance (accuracy = 0.69) out of nine models. In the testing cohort (62 cases), a total of 43 cases were correctly predicted of the quetiapine dose regimen. In dose subgroup analysis, AUROC for patients with daily dose of 100 mg, 200 mg, 300 mg and 400 mg were 0.99, 0.75, 0.93 and 0.86, respectively. CONCLUSIONS In this work, machine learning techniques are used for the first time to estimate the dose of quetiapine for patients with depression, which is valuable for the clinical drug recommendations.
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Affiliation(s)
- Yupei Hao
- Department of Clinical Pharmacy, the First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinyuan Zhang
- Beijing Medicinovo Technology Co., Ltd, Beijing, China
| | - Jing Yu
- Department of Clinical Pharmacy, the First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ze Yu
- Beijing Medicinovo Technology Co., Ltd, Beijing, China
| | - Lin Yang
- Department of Clinical Pharmacy, the First Hospital of Hebei Medical University, Shijiazhuang, China
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin Hao
- Dalian Medicinovo Technology Co., Ltd, Dalian, China
| | - Fei Gao
- Beijing Medicinovo Technology Co., Ltd, Beijing, China.
| | - Chunhua Zhou
- Department of Clinical Pharmacy, the First Hospital of Hebei Medical University, Shijiazhuang, China.
- The Technology Innovation Center for Artificial Intelligence in Clinical Pharmacy of Hebei Province, The First Hospital of Hebei Medical University, Shijiazhuang, China.
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Ceulemans A, Pinckaers FM, Postma AA, van Zwam WH, van Oostenbrugge RJ. Association Between Anemia and Clinical Outcome in Acute Ischemic Stroke Patients Treated With Endovascular Treatment. J Stroke 2024; 26:87-94. [PMID: 38246723 PMCID: PMC10850445 DOI: 10.5853/jos.2023.01669] [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: 05/21/2023] [Revised: 09/14/2023] [Accepted: 10/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND PURPOSE Endovascular treatment (EVT) is the preferred treatment option in eligible acute ischemic stroke (AIS) patients with a large vessel occlusion of the anterior circulation. Several comorbidities have been identified that can affect clinical outcomes. Various studies have investigated the association between anemia and clinical outcome and found conflicting. RESULTS . The aim is to investigate the association between pre-EVT anemia and clinical outcomes at different time points post-EVT, primarily focusing on the National Institutes of Health Stroke Scale (NIHSS) at 24-48 hours. METHODS We prospectively included 560 AIS patients who received EVT in the Maastricht University Medical Center+. Hemoglobin levels (Hb; g/dL) were determined on admission. Hb levels were also categorized into two groups: anemia (male: Hb ≤12.9 g/dL; female: Hb ≤11.9 g/dL) and no anemia. Multiple imputation was used to handle missing data. Multivariable regression was used to investigate the association between anemia or Hb levels and clinical outcomes. RESULTS Anemia was present in 26% of the patients. Multivariable regression did not show a significant association between anemia or Hb levels and NIHSS at 24-48 hours (adjusted β [aβ]anemia: 1.44, 95% confidence interval [CI]: -0.47 to 3.36; aβHb: -0.37, 95% CI: -0.88 to 0.13). However, multivariable regression showed significant associations with modified Rankin Scale (adjusted common odds ratio [acOR]anemia: 1.66, 95% CI: 1.12 to 2.48; acORHb: 0.83, 95% CI: 0.75 to 0.93) and poor functional outcome at 90 days (adjusted OR [aOR]anemia: 2.09, 95% CI: 1.21 to 3.63; aORHb: 0.80, 95% CI: 0.69 to 0.92). CONCLUSION Anemia was not independently associated with early neurological deficit (NIHSS) post-AIS, suggesting it is more suitable as a general frailty marker.
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Affiliation(s)
- Angelique Ceulemans
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Florentina M.E. Pinckaers
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Alida A. Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Wim H. van Zwam
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Robert J. van Oostenbrugge
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Wang Y, Guo D, Sui C, Qu Z, He G, Meng H, Duan Y, Zhang X, Lan L, Wang C, Liu X. Association between anemia and depression: results from NHANES 2005-2018 and mendelian randomization analyses. Ann Hematol 2023; 102:2651-2658. [PMID: 37481473 DOI: 10.1007/s00277-023-05374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The relationship between anemia and depression remains controversial. OBJECTIVE To explore the association between anemia/hemoglobin and depression. METHODS The data for our cross-sectional study were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Weighted multivariate logistic regression was performed to examine the association between anemia/hemoglobin and depression. Inverse variance weighted (IVW), weighted-median, and MR-Egger were used in MR analyses to assess the causal relationship between anemia/hemoglobin and depression. Heterogeneity and directional pleiotropy were assessed using the Cochrane Q test and Egger-intercept test, respectively. Sensitivity analysis was conducted by the leave-one-out approach. All analyses were carried out using IBM SPSS 24.0 and R version 4.2.2. RESULTS A total of 29,391 NHANES participants were included in this study. After adjusting for all covariates, the association between anemia/hemoglobin and depression was not significant (P < 0.05). IVW estimates revealed that broad anemia had no significant effect on the risk of depression (OR = 1.00, 95% CI = 0.99-1.01, P = 0.432). Findings of weighted median and MR-Egger were consistent with those from IVW (weighted median: OR = 1.00, 95% CI = 0.99-1.02; P = 0.547; MR-Egger: OR = 1.01, 95% CI = 0.98-1.03, P = 0.605). The results of three MR Analyses methods also showed no causal association between hemoglobin and depression. CONCLUSIONS Our findings do not support a causal association between anemia and depression. The association between hemoglobin concentration and depression was not statistically significant either.
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Affiliation(s)
- Yashan Wang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Dingjie Guo
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Chuanying Sui
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Zihan Qu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Guangliang He
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Hengyu Meng
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yuqing Duan
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Linwei Lan
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Chunpeng Wang
- School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin, China.
| | - Xin Liu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China.
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Haddad BI, Hamdan M, Alshrouf MA, Alzubi A, Khirsheh A, Al-Oleimat A, Aldabaibeh M, Al-Qaryouti R, Abulubbad W, Al-Saber M, Jabaiti M, Karam AM. Preoperative hemoglobin levels and mortality outcomes after hip fracture patients. BMC Surg 2023; 23:266. [PMID: 37658363 PMCID: PMC10474652 DOI: 10.1186/s12893-023-02174-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE Hip fracture surgery is associated with a risk of morbidity and mortality, with admission hemoglobin levels being a significant predictor of mortality risk. The aim of this study is to evaluate the relationship between the preoperative hemoglobin (Hb) levels and mortality in patients who underwent hip fracture surgeries, with the goal of enhancing prognosis prediction and reducing complications within this patient subset. In addition, to assess the characteristics of patients at a higher risk of postoperative mortality. METHODS This retrospective study was conducted at Jordan University Hospital, a single tertiary care and educational center. It included patients with hip fractures who underwent surgical repair at the Department of Orthopedic Surgery and were recruited between December 2019 and February 2022. We examined the relationships between preoperative hemoglobin status and variables such as age at admission, gender, fracture type, surgery type, comorbidities, duration of hospital stay, intensive care unit (ICU) admission, and survival outcomes. RESULTS We included 626 patients; the mean age was 76.27 ± 9.57 years. 3-month and 6-month mortality rates were 11.2% and 14.1%, respectively. The highest mortality was observed in patients aged over 80 years (n = 53/245, 21.6%), and in male patients (n = 53/300, 17.7%). The Hb level upon admission was lower in individuals who died within 6 months compared to those who survived (10.97 ± 2.02 vs. 11.99 ± 2.39, p < 0.001). In multivariate analysis, the independent factors that were statistically significant in the model included gender (OR = 1.867; 95% CI 1.122-3.107, p = 0.016), age (OR = 1.060; 95% CI 1.029-1.092; p < 0.001), hemoglobin level upon admission (OR = 0.827; 95% CI 0.721-0.949; p = 0.007), history of renal disease (OR = 1.958; 95% CI 1.014-3.784; p = 0.045), length of hospital stay (OR = 1.080; 95% CI 1.036-1.126; p < 0.001), and ICU admission (OR = 1.848; 95% CI 1.049-3.257; p = 0.034). CONCLUSION Our study illustrates that low hemoglobin levels, history of renal disease, along with male gender, advanced age, extended hospital stays, and ICU admission were significantly associated with 6-month mortality. Future investigations should consider assessing varying degrees of anemia based on hemoglobin concentrations to provide a more comprehensive understanding of anemia's impact on mortality. This study investigated the relationship between preoperative hemoglobin levels, patient characteristics, and mortality in patients who underwent hip fracture surgeries. The results showed that lower hemoglobin levels, history of renal disease, male gender, advanced age, extended hospital stays, and ICU admission were significant predictors for mortality.
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Affiliation(s)
- Bassem I Haddad
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Hamdan
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Ali Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan.
| | - Abdallah Alzubi
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ahmed Khirsheh
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ahmad Al-Oleimat
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | | | - Waleed Abulubbad
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Munther Al-Saber
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Jabaiti
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
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11
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Liu C, Zhou R, Peng X, Zhu T, Wei W, Hao X. Relationship between depressive symptoms and anemia among the middle-aged and elderly: a cohort study over 4-year period. BMC Psychiatry 2023; 23:572. [PMID: 37553590 PMCID: PMC10408197 DOI: 10.1186/s12888-023-05047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The association between anemia and depression has been demonstrated in previous studies, but it's still unclear whether depressive symptoms as a hazard factor for anemia. The findings of a large-scale cross-sectional and longitudinal examination of such an association of among the middle-aged and elderly individuals in China were presented in our study. METHODS The data from China Health and Retirement Longitudinal Study in 2011 and 2015 were evaluated. 10,179 and 5,887 participants were included in cross-sectional and longitudinal study, respectively. According to the World Health Organization, hemoglobin concentrations below 13 g/dL for males and 12 g/dL for females are considered anemia. The research population was separated into two groups based on scores of the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D-10): the group with depressed symptoms had a score of more than 10 points, and the group with depressive disorder had a score of more than 20 points. Multilevel logistic regression analyses were conducted to explore the relationship between anemia and varying degrees of depressive symptoms, utilizing three models based on adjusting for different types of covariates. RESULTS In our cross-sectional investigation, depression disorders were more likely to link to the occurrence of anemia (OR, 1.34; 95% CI, 1.02-1.77; P = 0.035). Additionally, there seems a linear connection between depression questionnaire scores and hemoglobin concentrations (r = - 0.053, P < 0.001). Depressive symptom was significantly associated with anemia over 4 years of follow-up, and the more intense the depressive symptoms, the greater the danger of anemia (depressive symptoms group: OR, 1.27; 95% CI, 1.02-1.57, P = 0.032; depressive disorder group: OR, 1.59; 95% CI, 1.12-2.25, P = 0.010). CONCLUSIONS Our findings suggest that depression symptoms seem related to anemia in the middle-aged and elderly in China cross-sectionally and longitudinally, and that the risk of anemia increases with the severity of depressive symptoms.
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Affiliation(s)
- Congqi Liu
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
| | - Ruihao Zhou
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
| | - Xilin Peng
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China
| | - Wei Wei
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China.
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China.
| | - Xuechao Hao
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China.
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District Chengdu, Chengdu, China.
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12
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Yang SH, Seifert CF. Evaluation of Bleeding in Orthopedic Surgery With Perioperative Use of Serotonergic Antidepressants. Ann Pharmacother 2023; 57:885-891. [PMID: 36314288 DOI: 10.1177/10600280221134108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The use of serotonergic antidepressants (SADs) is associated with an increase in bleeding, and their exposure during the perioperative period increases the potential bleeding risk in patients undergoing surgical operations. OBJECTIVE The purpose of this study was to compare the rates of bleeding between patients on perioperative SADs and those not on SADs in patients undergoing orthopedic surgical procedures. METHODS A retrospective cohort study was conducted with patients who were admitted to a single tertiary care county teaching hospital for orthopedic surgery. Outcomes evaluated were requirements of ≥ 2 units of packed red blood cells (PRBCs) and length of hospital stay for those requiring ≥ 2 units of PRBCs. RESULTS Of 273 patients, a significantly higher percentage of patients who received SADs required ≥ 2 units of PRBCs (19.3% vs 6.9%; P = 0.0049). Patients who required transfusion had a higher median (interquartile range [IQR]) age (79 [64-84.6] vs 65 [59-75]; P < 0.0001). The risk of requiring ≥ 2 units of PRBCs transfusion was greater for individuals having an anemia comorbidity (odds ratio [OR], 4.55; 95% CI, 1.95-10.62, P = 0.0004). Patients who required ≥ 2 units of PRBCs had a longer median hospital stay than those who did not receive ≥ 2 units of PRBCs (8 [5-10.1] vs 4 [3-5]; P < 0.0001). CONCLUSION AND RELEVANCE Receiving SADs in the perioperative period is associated with a higher transfusion requirement in patients undergoing orthopedic surgery. Clinicians should be aware of this increased risk for patients who are taking SADs while undergoing surgical procedures.
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Affiliation(s)
- Soon H Yang
- Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Charles F Seifert
- Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Satué K, Fazio E, La Fauci D, Bruschetta G, Medica P. Adaptive response of estrogen-iron axis in pregnant Purebred Spanish mares of different age. J Equine Vet Sci 2023:104827. [PMID: 37247748 DOI: 10.1016/j.jevs.2023.104827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
The maintenance of iron (Fe) homeostasis is vital for the physiological function along life. In sexually mature humans and experimental animals, estrogens downregulate hepcidin (Hpc) expression, in order to improve the intestinal absorption and to mobilize Fe stores for maternal erythropoietic expansion and placental development. However, changes of these mechanisms related to regulation of Hpc on the availability of Fe during gestation with advancing age in mares, remain unknown. The objective of this study was to evaluate the interrelationships between serum Fe, Ferritin (Ferr) and Hpc with estrone (E1) and estradiol-17β (E2) concentrations in pregnant mares of different ages. Blood samples were taken from 40 pregnant Spanish Purebred mares belonging to 4 different age groups, 10 subjects for each group: 4-6 years, 7-9 years, 10-12 years, and > 12 years were used in this study. Fe concentrations of 4-6 and 7-9 years groups were higher (P < .01) than 10-12 and >12 years groups. Ferr concentrations of 4-6 years group were higher (P < .01) than other groups. Hpc concentrations increased and E1 decreased (P < .01) in > 12 years group compared to other age groups. E2 concentrations of 7-9, 10-12 and >12 years groups were higher (P < .01) than those of 4-6 years group; 7-9 years group had higher E2 concentrations (P < .01) than > 12 years group. Fe and Ferr were negatively correlated with Hpc (r = -0.81 and r = -0.67, respectively). E1 and E2 were negatively correlated with Fe (r = -0.23 and r = -0.11, respectively). E2 was positively correlated with Hpc (r = 0.78). In pregnant Spanish Purebred mare, the increase of estrogens, according to the more efficient iron status in response to Hpc inhibition and consequent mobilization of circulating and iron reserve, shows the existence of "estrogen-iron axis" in young mares. Nevertheless, these mechanisms are reversed in old mares, suggesting a less efficient iron metabolism with advancing age. It is hoped that new investigations are needed to understand in depth and clarify further the complex metabolic and hormonal mechanisms involved also in equine species.
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Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Tirant lo Blanc, 7, Alfara del Patriarca, 46115 Valencia, Spain.
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
| | - Deborah La Fauci
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
| | - Giuseppe Bruschetta
- Department of Veterinary Sciences, Biochemistry Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
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Maezawa K, Nozawa M, Maruyama Y, Sakuragi E, Sugimoto M, Ishijima M. Comparison of anemia, renal function, and nutritional status in older women with femoral neck fracture and older women with osteoarthritis of the hip joint. J Orthop Sci 2023; 28:380-384. [PMID: 35000815 DOI: 10.1016/j.jos.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Several studies in older patients with femoral neck fracture found that preoperative anemia and malnutrition were associated with higher mortality and poorer physical function. Therefore, we compared nutritional status, Hb level, and renal function in women with femoral neck fracture and women of the same age with osteoarthritis of the hip joint. METHODS We enrolled 257 women aged 70 years and older who suffered femoral neck fracture (F group) or who were scheduled to undergo total hip arthroplasty for osteoarthritis of the hip joint (OA group). The F and OA groups were further divided into 2 groups on the basis of age, ie, 74 years old and younger (F70 and OA70) and 75 years old and older (F75 and OA75). To assess whether patients had undernutrition, mortality risk, anemia, and renal dysfunction, we assessed Geriatric Nutritional Risk Index (GNRI), Hb, and eGFR. RESULTS We found a significant difference in the mean Hb levels and GNRI scores between the F75 and OA75 and F70 and OA70. Moreover, we found a moderate correlation between Hb level and GNRI score in the F75 and OA75. With respect to the GNRI category, the percentage of patients at moderate or major risk was 42.1% in the F70 group and 57.6% in the F75 group but only 1.9% in the OA70 group and 4.3% in the OA75 group. CONCLUSION We found that women with femoral neck fracture had significantly lower Hb levels and lower GNRI scores than women with hip OA in the same age and that anemia and undernutrition were closely linked in women aged 75 and above. Moreover, we found that more than 40% of patients with a femoral neck fracture had a moderate to major risk on the basis of their GNRI scores.
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Affiliation(s)
- Katsuhiko Maezawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu City, Chiba, 279-0021, Japan.
| | - Masahiko Nozawa
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu City, Chiba, 279-0021, Japan
| | - Emi Sakuragi
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu City, Chiba, 279-0021, Japan
| | - Munehiko Sugimoto
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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15
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Kunz AL, Schönstein A, Bahrmann P, Giannitsis E, Wahl HW, Katus HA, Frey N, Bahrmann A. Exploring biomarkers in routine diagnostics for the risk stratification of older patients in the Chest Pain Unit: a prospective cohort study. BMJ Open 2022; 12:e056674. [PMID: 36572487 PMCID: PMC9806057 DOI: 10.1136/bmjopen-2021-056674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aims to estimate the association of the often, in daily clinical practice, used biological age-related biomarkers high-sensitivity troponin-T (hs-TnT), C reactive protein (CRP) and haemoglobin (Hb) with all-cause mortality for the purpose of older patient's risk stratification in the emergency department (ED). DESIGN Exploratory, prospective cohort study with a follow-up at 2.5 years after recruitment started. For the predictors, data from the hospital files including the routinely applied biological age-related biomarkers hs-TnT, CRP and Hb were supplemented by a questionnaire. SETTING A cardiological ED, Chest Pain Unit, University Hospital Heidelberg, Germany. PARTICIPANTS N=256 cardiological ED patients with a minimum age of 70 years and the capability to informed consent. PRIMARY OUTCOME MEASURES The primary outcome of this study was all-cause mortality which was assessed by requesting registry office information. RESULTS Among N=256 patients 63 died over the follow-up period. Positive results in each of the three biomarkers alone as well as the combination were associated with increased all-cause mortality at follow-up. The number of positive age-related biomarkers appeared to be strongly indicative of the risk of mortality, even when controlled for major confounders (age, sex, body mass index, creatinine clearance and comorbidity). CONCLUSIONS In older ED patients, biomarkers explicitly related to biological ageing processes such as hs-TnT, CRP and Hb were to a certain degree independently of each other as well as combined associated with an increased risk of all-cause mortality. Thus, they may have the potential to be used to supplement the general risk stratification of older patients in the ED. Validation of the results in a large dataset is needed.
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Affiliation(s)
- Anna Lisa Kunz
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anton Schönstein
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Philipp Bahrmann
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Werner Wahl
- Network Aging Research and Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anke Bahrmann
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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16
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Brożonowicz J, Ćwirlej-Sozańska A, Sozański B, Orzech-Janusz E, Garus A, Grzesik M, Wilmowska-Pietruszyńska A, Wiśniowska-Szurlej A. Relationship between Selected Functional Performance Parameters and the Occurrence of Anaemia in Hospitalized Females and Males Aged 80 and More. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13179. [PMID: 36293764 PMCID: PMC9603316 DOI: 10.3390/ijerph192013179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Anaemia is considered a factor that significantly increases the risk of disability and mortality in the elderly. Among the hospitalized elderly, the incidence of anaemia is higher than in the general population, which necessitates extensive diagnostics for anaemia in this group. The aim was to assess the relationship between the occurrence of anaemia in hospitalized females and males, aged 80 years and more, and selected determinants of motor fitness. The analysis covered 91 females and 57 males aged 80 and more. The study implemented haemoglobin level, handgrip strength, a lower limb strength, mobility and balance measurement. The analysis used the logistic regression model and the cut-off point was determined by ROC curve. A 1 kg increase in muscle strength reduced the risk of anaemia in a group of males by 12%. The value of handgrip strength from which anaemia can be predicted in a group of males is 24.4 kg. In the female group, no statistically significant correlations were found. There is a need to continue research in this area with the participation of a larger group of respondents to look for potential factors that may be related to anaemia, in order to find non-invasive diagnostic tools useful for elderly people.
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Affiliation(s)
- Justyna Brożonowicz
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Bernard Sozański
- Institute of Medicine, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Ewa Orzech-Janusz
- Geriatric Department at the District Hospital Named by Henryk Jankowski in Przeworsk, 37-200 Przeworsk, Poland
| | - Anna Garus
- Geriatric Department at the District Hospital Named by Henryk Jankowski in Przeworsk, 37-200 Przeworsk, Poland
| | - Magdalena Grzesik
- Geriatric Department at the District Hospital Named by Henryk Jankowski in Przeworsk, 37-200 Przeworsk, Poland
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The Prevalence of Anemia and Its Associated Factors among Older Persons: Findings from the National Health and Morbidity Survey (NHMS) 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094983. [PMID: 35564378 PMCID: PMC9101117 DOI: 10.3390/ijerph19094983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/15/2022] [Indexed: 12/21/2022]
Abstract
Background: There is limited evidence on the association of anemia with chronic diseases and disabilities among older persons in Malaysia. We assessed the prevalence of anemia and its associated factors among community-dwelling older persons. Methods: This was a cross-sectional study using data from the nationwide National Health and Morbidity Survey 2015 (NHMS 2015) on the health of older adults conducted by the Institute for Public Health, National Institutes of Health, Malaysia. A two-stage stratified random-cluster sampling design was utilized. Data were collected on the sociodemographic profiles, non-communicable disease (NCD) comorbidities (hypertension, diabetes and hypercholesterolemia status) and disabilities among the older persons. Anemia was defined based on the World Health Organization’s standards. A multivariable logistic regression analysis was used to assess the association of anemia with chronic diseases and disabilities. Results: The prevalence of anemia was 35.3% (95% CI: 33.1, 37.4) in the older persons. Chronic disease profiling showed that the prevalence rates of anemia among the older persons with diabetes, hypertension and hypercholesterolemia were 38.6%, 35.3% and 34.1%, respectively. In the multivariable analysis, persons aged 80 years and above (adjusted OR (aOR): 2.64; 95% CI: 2.00, 3.47), 70–79 years (aOR: 1.42; 95% CI: 1.21, 1.66), with diabetes (aOR: 1.30; 95% CI: 1.13, 1.51) and with disabilities in walking (aOR: 1.31; 95% CI: 1.11, 1.54) and self-care (aOR: 1.58; 95% CI: 1.22, 2.05) had higher odds of anemia compared to their respective reference categories. Among the persons with diabetes, the respondents aged 80 years and above (aOR: 2.48; 95% CI: 1.56, 3.94), 70–79 years old (aOR: 1.38; 95% CI: 1.08, 1.76) and with disabilities in vision (aOR: 1.29; 95% CI: 1.02, 1.63) and walking (aOR: 1.50; 95% CI: 1.18, 1.91) were more likely to be anemic. Furthermore, among the older persons without diabetes, persons aged 80 years and above (aOR: 2.89; 95% CI: 2.05, 4.07), 70–79 years old (aOR: 1.46; 95% CI: 1.19, 1.80) and with difficulty in self-care (aOR: 1.87; 95% CI: 1.30, 2.69) were more likely to be anemic. Conclusions: The resilient predictors of developing anemia were advancing age and diabetes, based on our study. Anemia is significantly associated with walking and vision disabilities among older persons with diabetes and with self-care difficulties in those without diabetes. There is a need for future studies to evaluate strategies to prevent anemia among older adults in order to promote healthy aging.
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Corona LP, Andrade FCD, da Silva Alexandre T, de Brito TRP, Nunes DP, de Oliveira Duarte YA. Higher hemoglobin levels are associated with better physical performance among older adults without anemia: a longitudinal analysis. BMC Geriatr 2022; 22:233. [PMID: 35313814 PMCID: PMC8939094 DOI: 10.1186/s12877-022-02937-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/21/2022] [Indexed: 01/17/2023] Open
Abstract
Background Anemia is the most common hematological abnormality among older adults, and it is associated with decreased physical performance. But the role of hemoglobin in the absence of anemia remains unclear. Thus, this study aimed to assess the impact of hemoglobin levels on physical performance in Brazilian older adults without anemia. Methods The study is longitudinal in that it relies on two waves of the Saúde, Bem-Estar e Envelhecimento (SABE; Health, Well-being, and Aging) study: 2010 and 2015-2016. Mixed-effects linear regression was used to determine the effects of the hemoglobin concentrations on the Short Physical Performance Battery-SPPB over time among the 1,023 who had complete data and did not have anemia in 2010. In the follow-up, there were 567 without anemia. Results In analyses adjusted for age, education, comorbidities, body mass index, and physical inactivity, we found a differential association between hemoglobin concentration and SBBP by sex, with a positive interaction (β Hb*female= 0.20, 95% CI 0.04,0.37). At lower levels of hemoglobin, women have lower levels of SPPB than men, but at higher levels of hemoglobin concentration, there are no sex differences in physical performance. In addition, higher age was negatively associated with SPPB levels and cardiometabolic diseases, other diseases, and physical inactivity. Education was positively associated with physical performance. Conclusion Our study demonstrates that higher hemoglobin levels were associated with better physical performance among older adults without anemia in Brazil. However, there were sex differences in this association. This finding is important because, in clinical practice, most health professionals focus on the World Health Organization definition of anemia. Our study suggests the importance of hemoglobin levels among older adults, even those without anemia, and highlights sex differences. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02937-4.
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Affiliation(s)
- Ligiana Pires Corona
- Faculty of Applied Sciences, University of Campinas (UNICAMP), R. Pedro Zaccaria, 1300 - 13484-350, Limeira, SP, Brazil.
| | - Flavia Cristina Drumond Andrade
- School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada St, Urbana, IL, 61801, United States of America
| | - Tiago da Silva Alexandre
- Gerontology Department, Federal University of Sao Carlos, Rodovia Washington Luís, km 235, SP-310, São Carlos, SP, Brazil
| | | | - Daniella Pires Nunes
- Medical-surgical Nursing Area, Faculty of Nursing, University of Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126, Campinas, SP, Brazil
| | - Yeda Aparecida de Oliveira Duarte
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, São Paulo, SP, Brazil
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Pancani S, Lombardi G, Sofi F, Gori AM, Boni R, Castagnoli C, Paperini A, Pasquini G, Vannetti F, Lova RM, Macchi C, Cecchi F. 12-month survival in nonagenarians inside the Mugello study: on the way to live a century. BMC Geriatr 2022; 22:194. [PMID: 35279074 PMCID: PMC8918304 DOI: 10.1186/s12877-022-02908-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Life expectancy has increased over the last century and a growing number of people is reaching age 90 years and over. However, data on nonagenarians’ health trends are scarce due to difficulties in investigating this specific population. This study aims to identify risk factors for one-year mortality in nonagenarians using data collected within the “Mugello Study”. Methods Complete information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 nonagenarians, as well as information about survival after 1 year from the interview. Results The sample included 314 women (72.5%) and 119 men (27.5%) with a median age of 92 years (range 90-99 years). The mortality rate was 20.3% (88 deaths). After adjustment for age and sex, a significantly higher risk of dying within 12 months was observed in individuals with more severe cognitive impairment (HR = 5.011, p < 0.001), more severe disability in basic activities of daily living (HR = 4.193, p < 0.001), sedentary lifestyle (HR = 3.367, p < 0.001), higher number of drugs assumed (HR = 1.118, p = 0.031), and kidney dysfunction (HR = 2.609, p = 0.004). When all the variables were included in the analysis, only older age (HR = 1.079, p = 0.048), lower cognitive function (HR = 2.859, p = 0.015), sedentary lifestyle (HR = 2.030, p = 0.026), and kidney dysfunction (HR = 2.322, p = 0.018) remained significantly associated with reduced survival. Conclusions Data from the Mugello study support the hypothesis that survival at 12 months in nonagenarians is not a stochastic process and that older age, reduced cognitive function, sedentary lifestyle, and the presence of kidney dysfunction are associated with mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02908-9.
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Marabini L, Pazzaglini C, Bonazzi S, Guasti P, Guerra G, Zurlo A, Zuliani G, Brombo G. Depressive symptoms and cognitive/functional status in a sample of elderly subjects referring to a memory clinic. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hematopoiesis, Inflammation and Aging-The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals. J Clin Med 2022; 11:jcm11030706. [PMID: 35160156 PMCID: PMC8836692 DOI: 10.3390/jcm11030706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/27/2023] Open
Abstract
Anemia and systemic signs of inflammation are common in elderly individuals and are associated with decreased survival. The common biological context for these two states is then the hallmarks of aging, i.e., genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication. Such aging-associated alterations of hematopoietic stem cells are probably caused by complex mechanisms and depend on both the aging of hematopoietic (stem) cells and on the supporting stromal cells. The function of inflammatory or immunocompetent cells is also altered by aging. The intracellular signaling initiated by soluble proinflammatory mediators (e.g., IL1, IL6 and TNFα) is altered during aging and contributes to the development of both the inhibition of erythropoiesis with anemia as well as to the development of the acute-phase reaction as a systemic sign of inflammation with increased CRP levels. Both anemia and increased CRP levels are associated with decreased overall survival and increased cardiovascular mortality. The handling of elderly patients with inflammation and/or anemia should in our opinion be individualized; all of them should have a limited evaluation with regard to the cause of the abnormalities, but the extent of additional and especially invasive diagnostic evaluation should be based on an overall clinical evaluation and the possible therapeutic consequences.
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Galbussera AA, Mandelli S, Rosso S, Zanetti R, Rossi M, Giacomin A, Detoma P, Riva E, Tettamanti M, Porta MGD, Lucca U. Mild anemia and 11- to 15-year mortality risk in young-old and old-old: Results from two population-based cohort studies. PLoS One 2021; 16:e0261899. [PMID: 34972180 PMCID: PMC8719676 DOI: 10.1371/journal.pone.0261899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mild anemia is a frequent although often overlooked finding in old age. Nevertheless, in recent years anemia has been linked to several adverse outcomes in the elderly population. Objective of the study was to investigate the association of mild anemia (hemoglobin concentrations: 10.0-11.9/12.9 g/dL in women/men) with all-cause mortality over 11-15 years and the effect of change in anemia status on mortality in young-old (65-84 years) and old-old (80+ years). METHODS The Health and Anemia and Monzino 80-plus are two door-to-door, prospective population-based studies that included residents aged 65-plus years in Biella municipality and 80-plus years in Varese province, Italy. No exclusion criteria were used. RESULTS Among 4,494 young-old and 1,842 old-old, mortality risk over 15/11 years was significantly higher in individuals with mild anemia compared with those without (young-old: fully-adjusted HR: 1.35, 95%CI, 1.15-1.58; old-old: fully-adjusted HR: 1.28, 95%CI, 1.14-1.44). Results were similar in the disease-free subpopulation (age, sex, education, smoking history, and alcohol consumption adjusted HR: 1.54, 95%CI, 1.02-2.34). Both age groups showed a dose-response relationship between anemia severity and mortality (P for trend <0.0001). Mortality risk was significantly associated with chronic disease and chronic kidney disease mild anemia in both age groups, and with vitamin B12/folate deficiency and unexplained mild anemia in young-old. In participants with two hemoglobin determinations, seven-year mortality risk was significantly higher in incident and persistent anemic cases compared to constant non-anemic individuals in both age groups. In participants without anemia at baseline also hemoglobin decline was significantly associated with an increased mortality risk over seven years in both young-old and old-old. Limited to the Monzino 80-plus study, the association remained significant also when the risk was further adjusted also for time-varying covariates and time-varying anemia status over time. CONCLUSIONS Findings from these two large prospective population-based studies consistently suggest an independent, long-term impact of mild anemia on survival at older ages.
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Affiliation(s)
- Alessia A. Galbussera
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Mandelli
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Roberto Zanetti
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Marianna Rossi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Paolo Detoma
- Laboratory of Analysis, Ospedale degli Infermi, Biella, Italy
| | - Emma Riva
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Matteo G. Della Porta
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Alvarez-Payares JC, Rivera-Arismendy S, Ruiz-Bravo P, Sánchez-Salazar SM, Manzur RA, Ramirez-Urrea SI, Puello A. Unexplained Anemia in the Elderly. Cureus 2021; 13:e19971. [PMID: 34984131 PMCID: PMC8714032 DOI: 10.7759/cureus.19971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/18/2022] Open
Abstract
Anemia is frequently diagnosed in elderly patients, and it is a key indicator of many reactive and clonal conditions. Furthermore, the older age is the most common presenting age for myelodysplastic syndromes (MDS). Anemia in older age may be attributed to an inflammatory state due to senescence, comorbidities, nutritional deficiencies, or primary bone marrow conditions. As diagnostic possibilities and life expectancy increase, the prevalence of anemia of the elderly increases as well. The etiology has a direct impact on the treatment and quality of life of these patients, in whom is a usual clinical challenge as it may be due to a multifactorial origin. In a minority group, when no etiology is identified, it is classified as unexplained anemia (UA) or clonal cytopenia of unknown significance (CCUS). The underlying cause of anemia remains unexplained in 30% of cases, and a great part of unexplained cytopenia may account for myeloid neoplasms. Anemia in the elderly is associated with worse cognitive and functional outcomes and increased mortality.
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Goal attainment scaling with older people in general practice: A feasibility study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2020.100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim JS, Choi S, Lee G, Cho Y, Park SM. Association of hemoglobin level with fracture: a nationwide cohort study. J Bone Miner Metab 2021; 39:833-842. [PMID: 33830350 DOI: 10.1007/s00774-021-01222-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The association between hemoglobin (Hb) level including anemia and fracture has not been studied thoroughly. MATERIALS AND METHODS 197, 187 adults ≥ 50 years from the National Health Insurance Service of Korea were studied. Hb was determined during health screening examinations in 2004 or 2005. From 1 January 2006, participants were followed up for fracture until 31 December 2013. Hb levels (g/dL) were categorized into five groups, with normal hemoglobin levels subdivided into three groups (low normal, normal, and high normal Hb): < 13, ≥ 13 to < 14, ≥ 14 to < 16, ≥ 16 to < 17, 17 for men and < 12, ≥ 12 to < 13, ≥ 13 to < 14, ≥ 14 to < 16, ≥ 16 for women. Anemia was defined as Hb < 13 g/dL and < 12 g/dL for men and women, respectively. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fracture according to Hb. RESULTS Compared to individuals with normal Hb, those with anemia and low normal Hb were associated with significantly increased risk of fracture. In women, those with anemia had a higher risk for any (aHR 1.11, 95% CI 1.05-1.17), hip (aHR 1.27, 95% CI 1.01-1.59), and radius fracture (aHR 1.15, 95% CI 1.05-1.25). In men, those with anemia had a higher risk for any (aHR 1.37, 95% CI 1.23-1.51), vertebral (aHR 1.33, 95% CI 1.15-1.53), and hip fracture (aHR 1.64, 95% CI 1.30-2.08). This risk-enhancing association was preserved among various subgroups. CONCLUSION Among adults ≥ 50 years, anemia and low normal Hb are risk factors for fracture.
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Affiliation(s)
- Ji Soo Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences and Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yoosun Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences and Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea.
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.
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The prognostic effect of hemoglobin on patients with cancer cachexia: a multicenter retrospective cohort study. Support Care Cancer 2021; 30:875-885. [PMID: 34392426 DOI: 10.1007/s00520-021-06486-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/04/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To clarify the influence of hemoglobin on cancer cachexia and to determine whether hemoglobin affects the prognosis or quality of life of patients with cancer cachexia and whether these effects are caused by an interaction between hemoglobin and other factors. MATERIAL AND METHODS This study was a multicenter cohort of 2715 patients with cancer cachexia diagnosed from June 2012 to December 2019. The primary outcomes and measures were overall survival (OS) time and all-cause mortality. The association between hemoglobin and all-cause mortality was evaluated using hazard ratios (HRs) and the restricted cubic spline model with a two-sided p-value. Optimal stratification was used to determine the threshold value. We also evaluated the cross-classification of hemoglobin and each variable with survival. RESULTS Among the 2715 participants diagnosed with cancer cachexia, 1592 (58.6%) were male, and the mean (SD) age was 58.8 (11.7) years. The optimal cutoff point for hemoglobin as a predictor of cancer cachexia mortality was 140 g/L for males and 101 g/L for females in our research. The decrease in hemoglobin was positively correlated with all-cause mortality. These associations were consistent across cancer subtypes. In the multivariable analysis, after adjusting for sex, age, TNM stage, tumor type, radiotherapy, chemotherapy, Karnofsky performance status score, and other factors, patients diagnosed with cancer cachexia who had low hemoglobin levels were more likely to have a worse prognosis (HR 2.40; 95% CI, 1.12-1.51). CONCLUSION Our results suggested that the proposed hemoglobin cutoff point would be valuable for prognostic prediction in patients with cancer cachexia, especially for long-term prognosis.
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Wangping J, Ke H, Shengshu W, Yang S, Shanshan Y, Wenzhe C, Yao H, Miao L. Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study. Front Med (Lausanne) 2021; 8:613426. [PMID: 33644094 PMCID: PMC7902775 DOI: 10.3389/fmed.2021.613426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals. Design: Prospective population-based cohort study. Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years). Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk. Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84-0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79-0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78-0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06-3.27). Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.
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Affiliation(s)
- Jia Wangping
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
- Department of Military Medical Technology Support, School of Non-commissioned Officer, Army Medical University, Shijiazhuang, China
| | - Han Ke
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wang Shengshu
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Song Yang
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yang Shanshan
- Department of Disease Prevention and Control, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Cao Wenzhe
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - He Yao
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Liu Miao
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
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Global cognition modifies the relationship between anemia and depression in old age: A longitudinal analysis of the IMIAS Study. Arch Gerontol Geriatr 2021; 94:104342. [PMID: 33508513 DOI: 10.1016/j.archger.2021.104342] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/26/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the relationship between anemia and depression and whether sex and global cognition modify this relationship over a 4-year follow-up. DESIGN Longitudinal analysis of an international cohort study SETTINGS AND PARTICIPANTS: Older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline. METHODS Participants were recruited in Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). The study outcome was depression, defined by a score of ≥16 in the Center for Epidemiologic Studies Depression Scale. Longitudinal associations over a 4-year follow-up were examined using generalized estimating equations. Cognition was ascertained with the Leganes Cognitive Test with scores ≤ 22 indicating poor cognition. Models were also adjusted for research sites, marital status, alcohol drinking status, body mass index, chronic conditions, activities of daily life disabilities, and polypharmacy. RESULTS Anemia and poor cognition at baseline were associated with an increased risk of depression at follow-up (OR = 5.73, 95% CI: 1.58-20.78). Global cognition was also an effect modifier of the longitudinal association between the severity of anemia and depression. CONCLUSIONS In international samples of older adults, anemia, as well as the severity of anemia, were independent risk factors for depression, and the effect of these associations was modified by global cognition. The findings highlight an important issue as to whether depression in old age may be at least partially preventable through public health interventions to correct low Hb levels.
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Yamaguchi Y, Zampino M, Tanaka T, Bandinelli S, Osawa Y, Ferrucci L, Semba RD. Elevated Plasma Growth and Differentiation Factor 15 Predicts Incident Anemia in Older Adults Aged 60 Years and Older. J Gerontol A Biol Sci Med Sci 2020; 76:1192-1197. [PMID: 33367500 DOI: 10.1093/gerona/glaa324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. We examined the relationship between plasma GDF-15 concentrations at baseline in 708 nonanemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased the risk of developing anemia (hazards ratio 1.15, 95% confidence interval 1.09, 1.21, p < .0001) compared to those in the lower 3 quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Circulating GDF-15 is an independent predictor for the development of anemia in older adults.
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Affiliation(s)
- Yuko Yamaguchi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marta Zampino
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Toshiko Tanaka
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | | | - Yusuke Osawa
- Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Richard D Semba
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Duman TT, Aktas G, Meryem Atak B, Kocak MZ, Kurtkulagi O, Bilgin S. General characteristics of anemia in postmenopausal women and elderly men. Aging Male 2020; 23:780-784. [PMID: 30945964 DOI: 10.1080/13685538.2019.1595571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In present study, we aimed to investigate anemia etiologies, underlying causes, laboratory markers of anemia, required interventions in postmenopausal women and elderly men. The medical data of the anemic subjects were recorded from the patients' files and computerized database of the institution and retrospectively analyzed. Study population grouped into two according to the gender; men and women. Medical data of men and women were compared. A total of 113 subjects enrolled to the study; 78 women and 35 men. 51 (65%) of women and 21 (60%) of men had iron deficiency anemia, 5 (6.4%) of women and 1 (2.9%) of men had anemia of chronic disease, 2 (2.6%) of women and 10 (28.6%) of men had vitamin B12 deficiency anemia. Forty seven (60.3%) of the women and 30 (85.7%) of the men had comorbidities. 47% of colonoscopies were normal in study population (44% of women and 50% of men). Etiology and causes of anemia should be carefully investigated in subjects with advanced age. Physicians should kept in mind that B12 deficiency and comorbidities were more common in elderly men and about half of the colonoscopy procedures in this population is unnecessary.
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Affiliation(s)
| | - Gulali Aktas
- Department of Internal Medicine, Bolu Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Burcin Meryem Atak
- Department of Internal Medicine, Bolu Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Mehmet Zahid Kocak
- Department of Internal Medicine, Bolu Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Ozge Kurtkulagi
- Department of Internal Medicine, Bolu Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Satilmis Bilgin
- Department of Internal Medicine, Bolu Abant Izzet Baysal University Hospital, Bolu, Turkey
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The effect of red blood cell transfusion on fatigability after hospital discharge. Blood Adv 2020; 4:5690-5697. [PMID: 33211825 DOI: 10.1182/bloodadvances.2020003364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022] Open
Abstract
In patients with anemia, there is interest in understanding the impact of red blood cell (RBC) transfusion on patient-reported outcomes such as fatigue. However, data from previous studies are mixed as to whether transfusion improves fatigue. One explanation for this is that prior studies have not examined whether changes in fatigue from transfusion may also affect patient activity levels. This is important because if transfusion reduces fatigue, patients may become more active, which could increase their fatigue. Thus, testing whether transfusion affects patients' fatigability, a measure of fatigue in the context of activity, may be more useful than testing the effect of transfusion on fatigue alone. The objective of this study was to test the effect of transfusion during hospitalization on patients' fatigability 7 days postdischarge. This prospective observational study included hospitalized general medicine patients with hemoglobin levels <10 g/dL. Patient-reported fatigability was collected during hospitalization and by telephone 7 days after discharge. Multivariable linear regression was used to test the association between receipt of a transfusion and fatigability 7 days postdischarge. Among the 350 patients participating, larger reductions in fatigability were observed with more transfused RBCs. Receipt of 1 U of RBCs was associated with a smaller reduction in fatigability, whereas receipt of 2 to 3 U of RBCs was associated with reductions in fatigability nearly 1 standard deviation from baseline and 3 times greater than patients receiving 1 U of RBCs. In hospitalized patients with anemia, receipt of a transfusion is associated with reductions in fatigability 7 days after hospital discharge.
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Jia W, Wang S, Liu M, Yang S, Cao W, Han K, He Y. Anemia in centenarians: prevalence and association with kidney function. ACTA ACUST UNITED AC 2020; 25:26-33. [PMID: 31861969 DOI: 10.1080/16078454.2019.1703448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives: Although anemia is a widespread condition that leads to an increase in morbidity and mortality, particularly as people age, little information on anemia in centenarians is available. The objective of this study was to determine the prevalence of anemia and examine the relationship between anemia and a decline in kidney function in Chinese centenarians.Methods: We conducted a population-based cross-sectional study of a sample of 1002 Chinese centenarians (180 men and 822 women) from 2014 to 2016. Anemia was defined as a hemoglobin level of <130 g/L for men and <120 g/L for women.Results: The prevalence of anemia and severe anemia (<100 g/L) were 68.5% (men, 76.1%; women, 66.8%) and 19.6% (men, 16.1%; women, 20.3%), respectively. The risk of anemia and estimated glomerular filtration rate (eGFR) showed a nonlinear relationship (nonlinear P = 0.021). The interaction analysis revealed that ethnicity and diabetes mellitus played a role in the association between the eGFR (<60 mL/min/1.73 m2) and anemia.Conclusion: Anemia is highly prevalent in Chinese centenarians, particularly among men. Decreased kidney function was an independent determinant of anemia, especially in Han participants and participants with diabetes mellitus. The possibility of decreased kidney function needs to be considered in the evaluation and treatment of anemia in centenarians.
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Affiliation(s)
- Wangping Jia
- Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China.,Department of Military Medical Technology Support, School of Non-commissioned Officer, Army Medical University, Shijiazhuang, People's Republic of China
| | - Shengshu Wang
- Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Miao Liu
- Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shanshan Yang
- Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wenzhe Cao
- Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ke Han
- Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yao He
- Institute of geriatrics, the 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Beijing, People's Republic of China
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Warner MA, Hanson AC, Frank RD, Schulte PJ, Go RS, Storlie CB, Kor DJ. Prevalence of and Recovery From Anemia Following Hospitalization for Critical Illness Among Adults. JAMA Netw Open 2020; 3:e2017843. [PMID: 32970158 PMCID: PMC7516623 DOI: 10.1001/jamanetworkopen.2020.17843] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Anemia is common and has been associated with poor outcomes in the critically ill population, yet the timing and extent of hemoglobin recovery remains incompletely described, which may have important implications for clinical outcomes following discharge from intensive care. OBJECTIVES To describe longitudinal changes in anemia status during and after critical illness and assess the associations between hemoglobin concentrations and postdischarge mortality. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted from January 1, 2010, to December 31, 2016, in Olmsted County, Minnesota; data analysis was performed from June 1 to December 30, 2019. Participants included 6901 adults (age ≥18 years) admitted to intensive care. MAIN OUTCOMES AND MEASURES Hemoglobin concentrations in the 12 months before hospitalization, during hospitalization, and in the 12 months after discharge, categorized by anemia severity (mild, hemoglobin ≥10.0 to <12.0 g/dL in women or ≥10.0 to <13.5 g/dL in men; moderate, hemoglobin ≥8.0 to <10.0 g/dL; and severe, hemoglobin <8.0 g/dL). Complete recovery from anemia, defined as attainment of nonanemic status by 12 months post hospitalization, and 12-month mortality were also evaluated. RESULTS Of the 6901 patients included in the study, 3792 were men (55%); median (interquartile range [IQR]) age was 67 (IQR, 52-79) years. Prehospitalization hemoglobin concentrations were available in 83% of the population (n = 5694), with median hemoglobin concentrations of 13.1 (IQR, 11.6-14.4) g/dL. Forty-one percent of the patients (n = 2320) had anemia preceding hospitalization. Hemoglobin values at hospital discharge were 10.8 g/dL (IQR, 9.5-12.4 g/dL), with 80% (n = 5182 of 6460) having anemia: 58% mild, 39% moderate, and 3% severe. The prevalence of anemia post hospitalization was 56% (95% CI, 55%-58%) at 3 months, 52% (95% CI, 50%-54%) at 6 months, and 45% (95% CI, 43%-47%) at 12 months among those alive with available hemoglobin measurements. Rates of complete recovery from anemia at 12 months were 58% (95% CI, 56%-61%) for mild anemia, 39% (95% CI, 36%-42%) for moderate anemia, and 24% (95% CI, 15%-34%) for severe anemia. Of those without baseline anemia surviving hospitalization, 74% of the patients were anemic at hospital discharge, with rates of complete 12-month recovery of 73% (95% CI, 69%-76%) for mild anemia, 62% (95% CI, 57%-68%) for moderate anemia, and 59% (95% CI, 35%-82%) for severe anemia. Higher hospital discharge hemoglobin concentrations were associated with decreased mortality after multivariable adjustment (hazard ratio, 0.95 per 1-g/dL increase; 95% CI, 0.90-0.99, P = .02). CONCLUSIONS AND RELEVANCE The findings of this study suggest that anemia is common and often persistent in the first year after critical illness. Further studies are warranted to identify distinct anemia recovery profiles and assess associations with clinical outcomes.
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Affiliation(s)
- Matthew A. Warner
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew C. Hanson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ryan D. Frank
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Phillip J. Schulte
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Curtis B. Storlie
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Daryl J. Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Erythrocyte Characteristics and the Risk of Depression in Late Life: A Population-Based Prospective Study. J Am Med Dir Assoc 2020; 21:1677-1683. [PMID: 32651133 DOI: 10.1016/j.jamda.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/12/2020] [Accepted: 05/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Inflammation and vascular dysregulation may contribute to the development of depression and impose a burden on erythropoiesis. This study aimed to identify the association of erythrocyte indices with the severity of depressive symptoms and risk of developing depressive disorders in the older people. DESIGN A prospective cohort study on a randomly sampled Korean older population; the baseline assessment from 2010 to 2012, the first follow-up assessment from 2012 to 2014, and the second follow-up assessment from 2014 to 2016 (mean follow-up duration = 3.4 years). SETTING A nationwide and community-based cohort. PARTICIPANTS A total of 4451 Koreans aged 60 years or older. METHODS We examined the associations of the values and changes in mean corpuscular volume, mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) with the risk of prevalent and incident depression using logistic regression analyses. RESULTS High MCH and MCHC in female participants and high MCHC in male participants were associated with high geriatric depression scale scores and risk of prevalent depression. In female participants, high- and middle-MCH tertile groups showed a 2.68- and 2.34-fold higher risk of incident depression than did the low tertile group. In male participants, the high-MCH tertile group showed a 1.79-fold higher risk of incident depression than did the low tertile group. In both sexes, the participants whose MCV changed to the high or middle tertile or remained in the high or middle tertile during the follow-up period, and whose MCH increased to the high tertile or remained in the high tertile, were at a higher risk of incident depression. CONCLUSIONS AND IMPLICATIONS Changes in erythrocyte may be associated with the risk of depression in older adults. This prospective study proposes a new perspective of the old hematologic parameters for understanding the pathophysiology of late-life depression.
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El Shemy SA, Amer FE, Madani HA. Impact of Iron Deficiency Anemia on Functional Abilities and Muscle Strength in Children with Spastic Cerebral Palsy. Pak J Biol Sci 2020; 22:214-219. [PMID: 31930864 DOI: 10.3923/pjbs.2019.214.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The most common nutritional deficiency is iron deficiency that leads to anemia. The purpose of the study was to investigate the impact of iron deficiency anemia on functional abilities and muscle strength in children with spastic cerebral palsy. MATERIALS AND METHODS One hundred children with spastic CP from both gender ranging in age from 4-6 years participated in this study. They were selected from the Outpatient Clinic of Pediatrics, Faculty of Physical Therapy, Cairo University. The selected children were assigned into 2 groups of equal number i.e., 5 children in each group. Group A included 50 anemic spastic CP children and Group B included 50 non-anemic spastic CP children. All children were evaluated for hemoglobin, serum iron, functional abilities, hand grip strength and knee extensor strength. RESULTS The results showed statistically significant differences in all measured variables between both groups in favor of group B (p<0.05). Additionally, there were strong positive significant correlations between hemoglobin and motor skills and muscle strength as well as serum iron and all measured variables. CONCLUSION Iron deficiency anemia had a negative impact on functional abilities and strength. Anemic children had a lower motor function scores and strength compared to non-anemic children.
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Prochaska MT, Zhang H, Alavi C, Meltzer DO. Fatigability: A new perspective on and patient-centered outcome measure for patients with anemia. Am J Hematol 2020; 95:E166-E169. [PMID: 32291785 DOI: 10.1002/ajh.25803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Micah T. Prochaska
- Department of MedicineSection of Hospital Medicine, The University of Chicago Chicago Illinois USA
| | - Hui Zhang
- Center for Health and The Social SciencesThe University of Chicago Chicago Illinois USA
| | - Cyrus Alavi
- Pritzker School of Medicine, The University of Chicago Chicago Illinois USA
| | - David O. Meltzer
- Department of MedicineSection of Hospital Medicine, The University of Chicago Chicago Illinois USA
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Noma T, Kabayama M, Gondo Y, Yasumoto S, Masui Y, Sugimoto K, Akasaka H, Godai K, Higuchi A, Akagi Y, Takami Y, Takeya Y, Yamamoto K, Ikebe K, Arai Y, Ishizaki T, Rakugi H, Kamide K. Association of anemia and SRH in older people: the
SONIC
study. Geriatr Gerontol Int 2020; 20:720-726. [DOI: 10.1111/ggi.13945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Tomoko Noma
- Division of Health SciencesOsaka University, Graduate School of Medicine Osaka Japan
| | - Mai Kabayama
- Division of Health SciencesOsaka University, Graduate School of Medicine Osaka Japan
| | - Yasuyuki Gondo
- Department of Clinical Thanatology and Geriatric Behavioral ScienceOsaka University, Graduate School of Human Sciences Osaka Japan
| | - Saori Yasumoto
- Department of Clinical Thanatology and Geriatric Behavioral ScienceOsaka University, Graduate School of Human Sciences Osaka Japan
| | - Yukie Masui
- Research Team for Human CareTokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Ken Sugimoto
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Hiroshi Akasaka
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Kayo Godai
- Division of Health SciencesOsaka University, Graduate School of Medicine Osaka Japan
| | - Atsuko Higuchi
- Division of Health SciencesOsaka University, Graduate School of Medicine Osaka Japan
| | - Yuya Akagi
- Division of Health SciencesOsaka University, Graduate School of Medicine Osaka Japan
| | - Yoichi Takami
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Yasushi Takeya
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Koichi Yamamoto
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry Osaka Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical ResearchKeio University School of Medicine Tokyo Japan
| | - Tatsuro Ishizaki
- Research Team for Human CareTokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Hiromi Rakugi
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Kei Kamide
- Division of Health SciencesOsaka University, Graduate School of Medicine Osaka Japan
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
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Vulser H, Lemogne C, Boutouyrie P, Côté F, Perier MC, Van Sloten T, Hoertel N, Danchin N, Limosin F, Jouven X, Empana JP. Depression, antidepressants and low hemoglobin level in the Paris Prospective Study III: A cross-sectional analysis. Prev Med 2020; 135:106050. [PMID: 32156564 DOI: 10.1016/j.ypmed.2020.106050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
Anemia is known to be associated with depression both in community and clinical populations. However, it is still unknown if this association depends or not on antidepressant intake. We investigated the respective association of depression and antidepressant intake with low hemoglobin level in a large community-based cohort. In 8640 volunteers aged 50 to 75 recruited between June 2008 and June 2012 in Paris (France), we assessed hemoglobin levels (g/dl), depressive symptoms and antidepressant intake. We examined the association of both depression and antidepressant intake with hemoglobin level, adjusting for numerous socio-demographic and health variables. We also assessed the association with specific antidepressant classes. Depression and antidepressant intake were independently associated with lower hemoglobin level (β = -0.074; p = .05 and β = -0.100; p = .02 respectively in the fully-adjusted model). Regarding antidepressant classes, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) intake were associated with lower hemoglobin level (β = -0.11; p = .01). To conclude, both depression and antidepressant intake were associated with lower hemoglobin level. In particular, as SSRI or SNRIs intake was also related to lower hemoglobin level, these classes should be used with caution in depressed individuals at risk for anemia.
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Affiliation(s)
- Hélène Vulser
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; AP-HP.Centre - Université de Paris, European Georges-Pompidou Hospital, Department of Psychiatry, Paris, France.
| | - Cédric Lemogne
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; AP-HP.Centre - Université de Paris, European Georges-Pompidou Hospital, Department of Psychiatry, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; AP-HP.Centre - Université de Paris, European Georges-Pompidou Hospital, Department of Pharmacology, Paris, France
| | - Francine Côté
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; AP-HP.Centre - Université de Paris, Necker Enfants Malades Hospital, Department of Hematology, Institut Imagine, INSERM U1183 CNRS ERL 8254, Laboratory of Excellence GR-Ex, Paris, France
| | - Marie-Cécile Perier
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; Inserm, UMR-S970, Paris Cardiovascular Research Center, Team 4 Integrative Epidemiology of Cardiovascular disease, Paris, France
| | - Thomas Van Sloten
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; Inserm, UMR-S970, Paris Cardiovascular Research Center, Team 4 Integrative Epidemiology of Cardiovascular disease, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nicolas Hoertel
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; AP-HP.Centre - Université de Paris, European Georges-Pompidou Hospital, Department of Psychiatry, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Paris, France
| | - Nicolas Danchin
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; AP-HP.Centre - Université de Paris, European Georges-Pompidou Hospital, Department of Cardiology, Paris, France; Preventive and Clinical Investigation Center, Paris, France
| | - Frédéric Limosin
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; AP-HP.Centre - Université de Paris, European Georges-Pompidou Hospital, Department of Psychiatry, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Paris, France
| | - Xavier Jouven
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; Inserm, UMR-S970, Paris Cardiovascular Research Center, Team 4 Integrative Epidemiology of Cardiovascular disease, Paris, France; AP-HP.Centre - Université de Paris, European Georges-Pompidou Hospital, Department of Cardiology, Paris, France
| | - Jean-Philippe Empana
- Université de Paris, Paris Descartes Faculty of Medicine, Paris, France; Inserm, UMR-S970, Paris Cardiovascular Research Center, Team 4 Integrative Epidemiology of Cardiovascular disease, Paris, France
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Elbarbary M, Honda T, Morgan G, Guo Y, Guo Y, Kowal P, Negin J. Ambient Air Pollution Exposure Association with Anaemia Prevalence and Haemoglobin Levels in Chinese Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093209. [PMID: 32380747 PMCID: PMC7246731 DOI: 10.3390/ijerph17093209] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health effects of air pollution on anaemia have been scarcely studied worldwide. We aimed to explore the associations of long-term exposure to ambient air pollutants with anaemia prevalence and haemoglobin levels in Chinese older adults. METHODS We used two-level linear regression models and modified Poisson regression with robust error variance to examine the associations of particulate matter (PM) and nitrogen dioxide (NO2) on haemoglobin concentrations and the prevalence of anaemia, respectively, among 10,611 older Chinese adults enrolled in World Health Organization (WHO) Study on global AGEing and adult health (SAGE) China. The average community exposure to ambient air pollutants (PM with an aerodynamic diameter of 10 μm or less (PM10), 2.5 μm or less (PM2.5), 1 μm or less (PM1) and nitrogen dioxide (NO2)) for each participant was estimated using a satellite-based spatial statistical model. Haemoglobin levels were measured for participants from dried blood spots. The models were controlled for confounders. RESULTS All the studied pollutants were significantly associated with increased anaemia prevalence in single pollutant model (e.g., the prevalence ratios associated with an increase in inter quartile range in three years moving average PM10 (1.05; 95% CI: 1.02-1.09), PM2.5 (1.11; 95% CI: 1.06-1.16), PM1 (1.13; 95% CI: 1.06-1.20) and NO2 (1.42; 95% CI: 1.34-1.49), respectively. These air pollutants were also associated with lower concentrations of haemoglobin: PM10 (-0.53; 95% CI: -0.67, -0.38); PM2.5 (-0.52; 95% CI: -0.71, -0.33); PM1 (-0.55; 95% CI: -0.69, -0.41); NO2 (-1.71; 95% CI: -1.85, -1.57) respectively. CONCLUSIONS Air pollution exposure was significantly associated with increased prevalence of anaemia and decreased haemoglobin levels in a cohort of older Chinese adults.
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Affiliation(s)
- Mona Elbarbary
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- Correspondence: ; Tel.: +61-416405016
| | - Trenton Honda
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA;
| | - Geoffrey Morgan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- School of Public Health, University Centre for Rural Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine at School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia;
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China;
| | - Paul Kowal
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
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Warner MA, Kor DJ, Frank RD, Dinglas VD, Mendez-Tellez P, Himmelfarb CRD, Shanholtz CB, Storlie CB, Needham DM. Anemia in Critically Ill Patients With Acute Respiratory Distress Syndrome and Posthospitalization Physical Outcomes. J Intensive Care Med 2020; 36:557-565. [DOI: 10.1177/0885066620913262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Anemia is common during critical illness and often persists after hospital discharge; however, its potential association with physical outcomes after critical illness is unclear. Our objective was to assess the associations between hemoglobin at intensive care unit (ICU) and hospital discharge with physical status at 3-month follow-up in acute respiratory distress syndrome (ARDS) survivors. Methods: This is a secondary analysis of a multisite prospective cohort study of 195 mechanically ventilated ARDS survivors from 13 ICUs at 4 teaching hospitals in Baltimore, Maryland. Multivariable regression was utilized to assess the relationships between ICU and hospital discharge hemoglobin concentrations with measures of physical status at 3 months, including muscle strength (Medical Research Council sumscore), exercise capacity (6-minute walk distance [6MWD]), and self-reported physical functioning (36-Item Short-Form Health Survey [SF-36v2] Physical Function score and Activities of Daily Living [ADL] dependencies). Results: Median (interquartile range) hemoglobin concentrations at ICU and hospital discharge were 9.5 (8.5-10.7) and 10.0 (9.0-11.2) g/dL, respectively. In multivariable regression analyses, higher ICU discharge hemoglobin concentrations (per 1 g/dL) were associated with greater 3-month 6MWD mean percent of predicted (3.7% [95% confidence interval 0.8%-6.5%]; P = .01) and fewer ADL dependencies (−0.2 [−0.4 to −0.1]; P = .02), but not with percentage of maximal muscle strength (0.7% [−0.9 to 2.3]; P = .37) or SF-36v2 normalized Physical Function scores (0.8 [−0.3 to 1.9]; P = .15). The associations of physical outcomes and hospital discharge hemoglobin concentrations were qualitatively similar, but none were statistically significant. Conclusions: In ARDS survivors, higher hemoglobin concentrations at ICU discharge, but not hospital discharge, were significantly associated with improved exercise capacity and fewer ADL dependencies. Future studies are warranted to further assess these relationships.
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Affiliation(s)
- Matthew A. Warner
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daryl J. Kor
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan D. Frank
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Victor D. Dinglas
- Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Pedro Mendez-Tellez
- Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carl B. Shanholtz
- Pulmonary & Critical Care Medicine, University of Maryland, Baltimore, MD, USA
| | - Curtis B. Storlie
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Pulmonary & Critical Care Medicine, Physical Medicine & Rehabilitation, and Nursing, Johns Hopkins University, Baltimore, MD, USA
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Gi YM, Jung B, Kim KW, Cho JH, Ha IH. Low handgrip strength is closely associated with anemia among adults: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES). PLoS One 2020; 15:e0218058. [PMID: 32196502 PMCID: PMC7083305 DOI: 10.1371/journal.pone.0218058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 02/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Anemia, which is a major public health problem worldwide, represents a decline in the oxygenation function, and can therefore be related to low strength. However, hemoglobin cannot repair muscles directly, but is beneficial only in a supportive role. Previous studies on the relationship between handgrip strength and anemia have been controversial. Thus, we aimed to analyze the association between handgrip strength and anemia in Korean adults. Methods This cross-sectional study used the 2013–2017 data from the 6th and 7th Korean National Health and Nutrition Examination Survey (KNHANES) that included 16,638 Korean adults, aged ≥19 years, who met the inclusion or exclusion criteria. Differences in sociodemographic factors (sex, age, education, income, and employment), lifestyle factors (alcohol consumption, smoking, and physical activity), and illness and health factors [body mass index (BMI), vitamin intake, iron intake, comorbid illnesses, and handgrip strength] by existence of anemia, were analyzed using the Chi square test. Binary logistic regression analysis was used to measure the association between handgrip strength and anemia, while adjusting for other possible confounders. Subgroup analysis, stratified by sex and age, was performed. Results Among Korean adults aged ≥19 years, 745,296 (7.7%) had anemia. A higher odds ratio, adjusted for other covariates/factors (OR) of anemia occurred in the weak handgrip strength group than in the strong handgrip strength group (OR = 1.92, 95% CI: 1.58–2.33). The subgroup analysis showed a higher OR adjusted for other covariates/factors of anemia in the weak handgrip strength group than in the strong handgrip strength group, regardless of sex or age. However, the association was greater for males (OR = 2.13, 95% CI: 1.35–3.34) and for those aged ≥65 years (OR = 1.92, 95% CI: 1.42–2.58). Conclusion This study showed a strong association between handgrip strength and anemia that was particularly strong for males and those aged ≥65 years.
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Affiliation(s)
- Yu-mi Gi
- Jaseng Hospital of Korean Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Boyoung Jung
- Department of Health Administration, Hanyang Women’s University, Seongdong-gu, Seoul, South Korea
- * E-mail: (BJ); (IHH)
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul, Republic of Korea
- * E-mail: (BJ); (IHH)
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Busti F, Marchi G, Lira Zidanes A, Castagna A, Girelli D. Treatment options for anemia in the elderly. Transfus Apher Sci 2019; 58:416-421. [DOI: 10.1016/j.transci.2019.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Rivilla Marugán L, Lorente Aznar T, Molinero Rodriguez M, García-Erce JA. [Anaemia and the elderly: Critical review of its definition and prevalence]. Rev Esp Geriatr Gerontol 2019; 54:189-194. [PMID: 31164237 DOI: 10.1016/j.regg.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of anaemia is an important health indicator, although there is little rigorous information gathered on the elderly population, particularly in those over 80 years old. The same criteria that are used in the general population are often used to define anaemia in the elderly. The epidemiological data collected by the WHO in 1968 (that have been used to generalise this criteria), did not include the population over 65 years-old. Two objectives are established, which includes a critical review of the available evidence on whether the criteria used to define anaemia in the adult population can be extrapolated to the elderly, and a review of publications on the prevalence of anaemia in the elderly over 80 years-old. MATERIAL AND METHODS A systematic bibliographic search was performed on the established objectives. RESULTS Although the WHO criteria, based on data from 1968, are widely used, other possible cut-off points have been proposed for elderly people. A total of 20 studies were found that were conducted in North America and Europe, with only 70,000 patients, and different age criteria. The prevalence of anaemia ranges between 3% and 63%, depending on the diagnostic criteria, age, and whether they were institutionalised or not. CONCLUSIONS Anaemia is a very prevalent disease in elderly patients. The collection of large databases is necessary to determine more adequate diagnostic criteria.
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Affiliation(s)
- Laura Rivilla Marugán
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - Teófilo Lorente Aznar
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - Mónica Molinero Rodriguez
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común».
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Hosseini SR, Zabihi A, Ebrahimi SH, Jafarian Amiri SR, Kheirkhah F, Bijani A. The Prevalence of Anemia and its Association with Depressive Symptoms among Older Adults in North of Iran. J Res Health Sci 2018; 18:e00431. [PMID: 30728317 PMCID: PMC6941631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/24/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Anemia is the most prevalent blood disorder in older adults which can have negative effects on the quality of life and lead to the onset of depressive symptoms. We aimed to determine the prevalence of anemia accompanied by depression among older people in the city of Amirkola, north of Iran. STUDY DESIGN A cross-sectional study. METHODS Overall, 1616 older people aged 60 and over (883 males and 733 females) were enrolled in the city of Amirkola, north of Iran since 2011. To diagnose anemia we used WHO criterion which is a hemoglobin value of less than 12 and 13 g/dl in women and men, respectively. We also used Geriatric Depression Scale (GDS) to detect the presence of depression symptoms. The data were analyzed using SPSS version18.0 and statistical tests. RESULTS The prevalence of anemia was 19% (302 out of 1616 participants). The prevalence of anemia in women was 20.3% and in men was 17.9%. In people with and without depressive symptoms it was 23.2% and 15.8%, respectively. The mean hemoglobin level in people with and without depressive symptoms was 13.29 ±1.63 and 13.96 ±1.50, respectively (P<0.001). According to logistic regression model, depressive symptoms were most highly related to gender (OR=3.67; 95% CI: 2.80, 4.81) and besides that smoking, Mini-Mental Estate Examination (MMSE), diabetes and anemia (OR=1.46; 95% CI: 1.09, 1.95) were related to depression. CONCLUSION Significant prevalence of anemia and direct association with depressive symptoms in the elderly reflect the need for proper planning for prevention interventions, accurate and continuous screening of these diseases.
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Affiliation(s)
- Seyed Reza Hosseini
- 1 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- 2 Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
,Correspondence:Ali Zabihi (PhD) Tel: +98 1132190597 Fax: +98 1132199936 E-mail:
| | | | | | - Farzan Kheirkhah
- 5 Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- 1 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Hematological parameters and all-cause mortality: a prospective study of older people. Aging Clin Exp Res 2018; 30:517-526. [PMID: 28664457 PMCID: PMC5911276 DOI: 10.1007/s40520-017-0791-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
Background The effect of low and high concentration of some hematological parameters in the blood can have a negative impact on health. Aim Therefore, we investigated the associations between hematological parameters and all-cause mortality among older people living in Poland. Methods The study was carried out among 75–80-year-old participants (n = 403) from Warsaw and Olsztyn regions, Poland. Information on lifestyle factors and food consumption were obtained at baseline (June 1, 1999) using a self-administered questionnaire. Red blood cell, haemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) were determined. The data on deaths from all-causes were collected from the baseline until October 31, 2006. During an average of 7.4 years of follow-up, we ascertained 154 cases of death from all-causes. Results Compared with men in the lowest tertile of MCV, MCH, and MCHC, the multivariable hazard ratios (HRs) of all-cause mortality in those in the highest tertile were 0.35 (95% CI, 0.17–0.73), 0.32 (95% CI, 0.16–0.67), and 0.44 (95% CI, 0.22–0.88), respectively. In contrast, among women after combining the second and the third tertiles of MCV, MCH, and MCHC, the HRs were 2.01 (95% CI, 1.01–3.99), 1.71 (95% CI, 0.85–3.43), and 1.09 (95% CI, 0.62–1.94), respectively. Discussion/conclusion We observed inverse associations between some hematological parameters and all-cause mortality among men, but not among women. This may be explained by a difference in iron metabolism, iron status, hormone regulations, or the occurrence of some diseases.
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Anemia at older age: etiologies, clinical implications, and management. Blood 2018; 131:505-514. [DOI: 10.1182/blood-2017-07-746446] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/05/2017] [Indexed: 12/29/2022] Open
Abstract
Abstract
Anemia is quite frequently diagnosed in older individuals and is a key indicator of various reactive and clonal conditions. Many underlying diseases, like myelodysplastic syndrome (MDS), develop preferentially in elderly individuals. The prevalence of anemia at older age is increasing, and this is mainly attributable to more frequently applied diagnostics and demographic changes in our societies. The etiology of anemia at older age is complex and ranges from bone marrow failure syndromes to chronic kidney disease, and from nutritional deficiencies to inflammatory processes including inflammaging in immunosenescence. In a smaller number of cases, no clear-cut etiology is identified. These patients are referred to as unexplained anemia or idiopathic cytopenia of unknown significance. In others, somatic mutations in leukocytes are found, but diagnostic criteria for MDS or other hematologic diseases are not fulfilled, a condition termed clonal cytopenia of undetermined significance. Management of anemias at older age depends on (1) the severity of the anemia, (2) underlying condition(s), and (3) patient-related factors, including comorbidities. Even a mild anemia may substantially affect physical and cognitive capacities and quality of life. An underestimated aspect is that because of age-related changes, organ function such as erythropoietin production in the kidney may become suboptimal. Management and treatment of anemia in older patients often require a multidisciplinary approach and detailed investigations of organ function. In this article, we review current concepts around anemias at older age, with special emphasis on etiologies, clinical implications, and innovative concepts in the management of these patients.
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Cecchi F, Pancani S, Vannetti F, Boni R, Castagnoli C, Paperini A, Pasquini G, Sofi F, Molino-Lova R, Macchi C. Hemoglobin concentration is associated with self-reported disability and reduced physical performance in a community dwelling population of nonagenarians: the Mugello Study. Intern Emerg Med 2017; 12:1167-1173. [PMID: 29071662 PMCID: PMC5691100 DOI: 10.1007/s11739-017-1762-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/14/2017] [Indexed: 02/06/2023]
Abstract
People aged 90 and older represent a fast-growing population segment who deserve specific attention and research. Aging is associated with a progressive decrease in hemoglobin concentration, which predicts adverse outcome, such as mortality, morbidity, frailty and disability. Whether this association is independent from increased prevalence of comorbidity, causing both anemia and reduced physical function is yet under debate. The aim of this study is to explore the relationship between hemoglobin concentration and self-reported disability and reduced physical performance in a community dwelling population of nonagenarians. Data presented were collected in the framework of the Mugello Study, a clinical epidemiologic survey of nonagenarians living in the Mugello area (Tuscany, Italy). 251 persons (177 women, age 93.2 ± 3.3 years; 74 men, age 92.2 ± 2.5 years) underwent a blood draw. Along with hemoglobin concentration, self-reported disability (basic and instrumental activities of daily living), physical performance (Short Physical Performance Battery), self-reported physical activity and muscular strength (handgrip measurement) were assessed. Covariates, inherent sociodemographic and health indicators and comorbidities were also included in the analysis. This study confirms that anemia is very common in the oldest old, with a significantly higher prevalence in males (50% in men vs 24% in women). Multiple linear regression analysis, including all the comorbid conditions as confounding factors, shows that hemoglobin concentration is independently associated with handgrip strength, self-reported physical activity and disability in dressing, and taking a shower/bath. In conclusion, results from this study confirm that in the oldest old, low hemoglobin concentration is strongly associated with self-reported disability and decline of physical performance independent of comorbidity.
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Affiliation(s)
- Francesca Cecchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Silvia Pancani
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Federica Vannetti
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Roberta Boni
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Chiara Castagnoli
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Anita Paperini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Guido Pasquini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Francesco Sofi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Molino-Lova
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Claudio Macchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Mayr NP, Wiesner G, Hapfelmeier A, van der Starre P, Husser O, Bleiziffer S, Schunkert H, Lange R, Tassani-Prell P, Martin K. Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2017; 92:141-148. [PMID: 29130582 DOI: 10.1002/ccd.27382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/13/2017] [Accepted: 09/28/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this investigation was to identify patient's characteristics and periprocedural variables related to periprocedural transfusion in transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI). BACKGROUND Transfusion of allogenic red-blood cells (RBC) in tf-TAVI and the number of transfused units has been linked to an increased 30-day mortality. In line with the trend of minimization and cost-effectiveness, transfusion should be avoided, wherever possible. METHODS Between 2007 and 2015, 1,734 procedures were analyzed from our prospective registry for RBC-transfusion. Multiple logistic regression analysis was used to identify the dependent variables. RESULTS Transfusion was considered necessary in 14% (n = 243) of the patients. Female gender (OR [95% CI]) (1.680 [1.014-2.783]) and preprocedural moderate (7.594 [4.404-13.095]) and severe anemia (8.202 [0.900-74.752]) according to WHO were the most important preprocedural variables. Periprocedural, pericardial effusion (12.109 [3.753-39.063]), emergency extracorporeal circulation (54.5288 [6.178-481.259]) and major vascular injury (2.647 [1.412-4.962]) were related to transfusion. The same applies to moderate (4.255 [1.859-9.740]) and severe anemia (31.567 [8.560-116.416]) as well as periprocedural experience (0.072 [0.035-0.149] - 0.141[0.079-0.251], P < 0.001) CONCLUSION: Procedural experience, serious adverse events, low pre- and periprocedural Hb levels and female gender were the main variables relating to transfusion. Even in experienced high-volume centers, transfusion is still necessary in a considerable number of patients.
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Affiliation(s)
- N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany
| | - Gunther Wiesner
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany
| | - Alexander Hapfelmeier
- Institut für Medizinische Statistik und Epidemiologie, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr. 22, Munich, D-81675, Germany
| | - Pieter van der Starre
- Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, MC 5640, Stanford, California, 94305
| | - Oliver Husser
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany
| | - Sabine Bleiziffer
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Rüdiger Lange
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Peter Tassani-Prell
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany
| | - Klaus Martin
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636, Germany
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Tuck MG, Alemi F, Shortle JF, Avramovic S, Hesdorffer C. A Comprehensive Index for Predicting Risk of Anemia from Patients' Diagnoses. BIG DATA 2017; 5:42-52. [PMID: 28328253 DOI: 10.1089/big.2016.0073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article demonstrates how time-dependent, interacting, and repeating risk factors can be used to create more accurate predictive medicine. In particular, we show how emergence of anemia can be predicted from medical history within electronic health records. We used the Veterans Affairs Informatics and Computing Infrastructure database to examine a retrospective cohort of 9,738,838 veterans over an 11-year period. Using International Clinical Diagnoses Version 9 codes organized into 25 major diagnostic categories, we measured progression of disease by examining changes in risk over time, interactions in risk of combination of diseases, and elevated risk associated with repeated hospitalization for the same diagnostic category. The maximum risk associated with each diagnostic category was used to predict anemia. The accuracy of the model was assessed using a validation cohort. Age and several diagnostic categories significantly contributed to the prediction of anemia. The largest contributors were health status ([Formula: see text] = -1075, t = -92, p < 0.000), diseases of the endocrine ([Formula: see text] = -1046, t = -87, p < 0.000), hepatobiliary ([Formula: see text] = -1043, t = -72, p < 0.000), kidney ([Formula: see text] = -1125, t = -111, p < 0.000), and respiratory systems ([Formula: see text] = -1151, t = -89, p < 0.000). The AUC for the additive model was 0.751 (confidence interval 74.95%-75.26%). The magnitude of AUC suggests that the model may assist clinicians in determining which patients are likely to develop anemia. The procedures used for examining changes in risk factors over time may also be helpful in other predictive medicine projects.
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Affiliation(s)
- Matthew G Tuck
- 1 Veterans Affairs Medical Center , Washington, District of Columbia
| | - Farrokh Alemi
- 2 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia
| | - John F Shortle
- 3 Systems Engineering and Operations Research, George Mason University , Fairfax, Virginia
| | - Sanj Avramovic
- 2 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia
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