Impact of anemia on outcome in critically ill patients with severe acute renal failure |
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Authors: | Damien du Cheyron Jean-Jacques Parienti Mohamed Fekih-Hassen Cédric Daubin Pierre Charbonneau |
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Affiliation: | (1) Department of Medical Intensive Care, Caen University Hospital, Av côte de Nacre, 14033 Caen Cedex, France;(2) Department of Infectious Diseases, Caen University Hospital, Av côte de Nacre, 14033 Caen Cedex, France |
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Abstract: | Objective To evaluate the prognostic value of hemoglobin levels in critically ill patients with acute renal failure (ARF) requiring dialysis.Design and setting A prospective observational cohort study in two adult medical ICUs.Patients 206 consecutive patients with ARF who required dialysis. Overall 28-day mortality was 48%.Measurements and results At ICU admission mean hemoglobin level was 9.1±2.1 g/dl. By ROC curve analysis the threshold value of hemoglobin with the highest sensibility/specificity was 9 g/dl. At baseline 63% of patients had anemia, defined as initial hemoglobin below 9 g/dl. Kaplan-Meier analysis showed that these patients had lower survival rate than those with hemoglobin above 9 g/dl. By multivariable analysis three factors were independently associated with 28-day death: hemoglobin lower than 9 g/dl (adjusted odds ratio 2.4, 95% CI 1.1–5.2), age, and SOFA score. Based on age and SOFA a matched cohort analysis of 67 pairs of ARF patients with or without anemia found similar results regarding the negative impact of anemia on outcome. Finally, a multivariable logistic regression analysis on matched cohort identified hemoglobin level below 9 g/dl (adjusted odds ratio 1.32, 95%CI 1.15–1.46), continuous renal replacement therapy, and vasoactive therapy as independent predictors of 28-day death.Conclusions These results suggest that initial hemoglobin level could be helpful in identifying patients with ARF requiring dialysis at high risk of death.This article refers to the editorial |
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Keywords: | Renal failure, acute Renal replacement therapy Intensive care units Assessment, outcome Anemia Erythrocyte transfusion |
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