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Saturday, October 12, 2013

Hospital-acquired anemia associated with increased mortality, study finds

Hospital-acquired anemia (HAA) is common and appears to be associated with increased mortality rates, according to a new study.

Researchers analyzed hospitalizations at 1 academic medical center and 9 community hospitals in the Cleveland Clinic Health System from Jan. 1, 2009, to Aug. 31, 2011, to evaluate the prevalence of HAA and to determine whether an association existed among HAA and increased mortality, length of stay (LOS) or total hospital charges. Mild HAA was defined as hemoglobin levels >11 g/dL and <12 g/dL in women and >11 g/dL and <13 g/dL in men, moderate HAA was defined as a hemoglobin level of 9.1 to ≤11.0 g/dL, and severe HAA was defined as a hemoglobin level ≤9.0 g/dL. Information on demographics, comorbid conditions and outcomes was obtained from administrative data, while data on hemoglobin values were obtained from the electronic medical record. The study appeared in the September Journal of Hospital Medicine.

Among the 188,447 hospitalizations included in the analysis, 139,807 patients (74%) developed HAA. HAA was mild in 29% of cases, moderate in 41% and severe in 30%. Patients were more likely to develop HAA if they were older and had more comorbid conditions. Risk-adjusted odds ratios for in-hospital mortality in patients with HAA were 1.0 for mild HAA (P=0.8), 1.51 for moderate HAA (P<0.001) and 3.28 for severe HAA (P<0.001). Patients with HAA also had higher risk-adjusted relative mean LOS and hospital charges compared with patients who didn't have HAA; risk-adjusted odds ratios were 1.08, 1.28 and 1.8 for LOS and 1.06, 1.18 and 1.80 for hospital charges with mild, moderate and severe HAA, respectively (P<0.001 for all comparisons).

The authors noted that their study used administrative data, involved only 1 health system and did not address treatment, among other limitations. However, they concluded, HAA is common during hospitalization and can have important effects on health care.

"Hospitals must continue to focus on improving patient safety and raising awareness of HAA and other modifiable hospital-acquired conditions," they wrote. "Closer prospective investigation for both medical and surgical patients of cumulative blood loss from laboratory testing, procedural blood loss, and a risk-benefit analysis of treatment options is necessary."

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