Prognostic importance of anaemia in patients with acute pulmonary embolism

Jacques Donzé; José Labarère; Marie Méan; David Jiménez; Drahomir Aujesky

doi:10.1160/TH11-04-0208

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2011; 106(02): 289-295
DOI: 10.1160/TH11-04-0208

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Prognostic importance of anaemia in patients with acute pulmonary embolism

Jacques Donzé

¹Division of General Internal Medicine, University of Lausanne, Lausanne, Switzerland

,

José Labarère

²TIMC, UMR 5525 CNRS Université Joseph Fourier, Grenoble, France

,

Marie Méan

¹Division of General Internal Medicine, University of Lausanne, Lausanne, Switzerland

,

David Jiménez

³Respiratory Department, Ramòn y Cajal Hospital, IRYCIS, Madrid, Spain

,

Drahomir Aujesky

⁴Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland

› Institutsangaben

Abstract

Summary

Although associated with adverse outcomes in other cardiopulmonary diseases, limited evidence exists on the prognostic value of anaemia in patients with acute pulmonary embolism (PE). We sought to examine the associations between anaemia and mortality and length of hospital stay in patients with PE. We evaluated 14,276 patients with a primary diagnosis of PE from 186 hospitals in Pennsylvania, USA. We used random-intercept logistic regression to assess the association between anaemia at the time of presentation and 30-day mortality and discretetime logistic hazard models to assess the association between anaemia and time to hospital discharge, adjusting for patient (age, gender, race, insurance type, clinical and laboratory variables) and hospital (region, size, teaching status) factors. Anaemia was present in 38.7% of patients at admission. Patients with anaemia had a higher 30-day mortality (13.7% vs. 6.3%; p <0.001) and a longer length of stay (geometric mean, 6.9 vs. 6.6 days; p <0.001) compared to patients without anaemia. In multivariable analyses, anaemia remained associated with an increased odds of death (OR 1.82, 95% CI: 1.60–2.06) and a decreased odds of discharge (OR 0.85, 95% CI: 0.82–0.89). Anaemia is very common in patients presenting with PE and is independently associated with an increased short-term mortality and length of stay.

Keywords

Risk factors - lung - thrombosis

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References
1 Sabatine MS, Morrow DA, Giugliano RP. et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005; 111: 2042-2049.
2 Groenveld HF, Januzzi JL, Damman K. et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol 2008; 52: 818-827.
3 Waterer GW, Kessler LA, Wunderink RG. Medium-term survival after hospitalization with community-acquired pneumonia. Am J Respir Crit Care Med 2004; 169: 910-914.
4 Chambellan A, Chailleux E, Similowski T. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy. Chest 2005; 128: 1201-1208.
5 Cote C, Zilberberg MD, Mody SH. et al. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007; 29: 923-929.
6 Young JB, Abraham WT, Albert NM. et al. Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry). Am J Cardiol 2008; 101: 223-230.
7 Kosiborod M, Curtis JP, Wang Y. et al. Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project. Arch Intern Med 2005; 165: 2237-2244.
8 Nordyke RJ, Kim JJ, Goldberg GA. et al. Impact of anemia on hospitalization time, charges, and mortality in patients with heart failure. Value Health 2004; 7: 464-471.
9 DeFrances CJ, Cullen KA, Kozak LJ. National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Stat 2007; 13: 1-209.
10 Aujesky D, Obrosky DS, Stone RA. et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005; 172: 1041-1046.
11 Jimenez D, Escobar C, Marti D. et al. Association of anaemia and mortality in patients with acute pulmonary embolism. Thromb Haemost 2009; 102: 153-158.
12 Aujesky D, Roy PM, Le Manach CP. et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J 2006; 27: 476-481.
13 Donzé J, Grégoire Le, Gal G, Fine MJ. et al. rospective validation of the Pulmonary Embolism Severity Index: A clinical prognostic model for pulmonary embolism. Thromb Haemost 2008; 100: 943-948.
14 Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?. Blood 2006; 107: 1747-1750.
15 Anker SD, Voors A, Okonko D. et al. Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTI- MAAL trial. Eur Heart J 2009; 30: 1331-1339.
16 Komajda M, Anker SD, Charlesworth A. et al. The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 2006; 27: 1440-1446.
17 MacMahon B. The National Death Index. Am J Public Health 1983; 73: 1247-1248.
18 Williams BC, Demitrack LB, Fries BE. The accuracy of the National Death Index when personal identifiers other than Social Security number are used. Am J Public Health 1992; 82: 1145-1147.
19 Cowper DC, Kubal JD, Maynard C. et al. A primer and comparative review of major US mortality databases. Ann Epidemiol 2002; 12: 462-468.
20 Ibrahim SA, Stone RA, Obrosky DS. et al. Thrombolytic therapy and mortality in patients with acute pulmonary embolism. Arch Intern Med 2008; 168: 2181-2190.
21 Torbicki A, Perrier A, Konstantinides S. et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-2315.
22 Ruiz-Gimenez N, Suarez C, Gonzalez R. et al. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 2008; 100: 26-31.
23 Anand IS, Chandrashekhar Y, Ferrari R. et al. Pathogenesis of oedema in chronic severe anaemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones. Br Heart J 1993; 70: 357-362.
24 White RH, Garcia M, Sadeghi B. et al. Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States. Thromb Res 2010; 126: 61-67.
25 Kearon C, Kahn SR, Agnelli G. et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 454S-545S.
26 Sam A, Sanchez D, Gomez V. et al. Usefulness of the shock index and the simplified pulmonary embolism severity index for identification of low-risk patientes with acute pulmonary embolism. Eur Respir J 2011; 37: 762-766.