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Ann Intern Med. 2019 Jan 15;170(2):81-89. doi: 10.7326/M17-3253. Epub 2018 Dec 18.

Long-Term Outcomes Among Patients Discharged From the Hospital With Moderate Anemia: A Retrospective Cohort Study.

Author information

1
Kaiser Permanente Northern California, Oakland, and Blood Systems Research Institute and University of California, San Francisco, San Francisco, California (N.H.R.).
2
Blood Systems Research Institute and University of California, San Francisco, San Francisco, California (E.L.M.).
3
Kaiser Permanente Northern California, Oakland, California (D.G.M., C.L., P.K., V.X.L., G.J.E.).
4
Institute for Transfusion Medicine, Pittsburgh, Pennsylvania (D.J.T.).
5
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.L.C.).
6
University of British Columbia, Victoria, British Columbia, Canada (S.K.).

Abstract

Background:

Randomized clinical trial findings support decreased red blood cell (RBC) transfusion and short-term tolerance of in-hospital anemia. However, long-term outcomes related to changes in transfusion practice have not been described.

Objective:

To describe the prevalence of anemia at and after hospital discharge and associated morbidity and mortality events.

Design:

Retrospective cohort study.

Setting:

Integrated health care delivery system with 21 hospitals serving 4 million members.

Participants:

445 371 surviving adults who had 801 261 hospitalizations between January 2010 and December 2014.

Measurements:

Hemoglobin levels and RBC transfusion, rehospitalization, and mortality events within 6 months of hospital discharge. Generalized estimating equations were used to examine trends over time, accounting for correlated observations and patient-level covariates.

Results:

From 2010 to 2014, the prevalence of moderate anemia (hemoglobin levels between 7 and 10 g/dL) at hospital discharge increased from 20% to 25% (P < 0.001) and RBC transfusion declined by 28% (39.8 to 28.5 RBC units per 1000 patients; P < 0.001). The proportion of patients whose moderate anemia had resolved within 6 months of hospital discharge decreased from 42% to 34% (P < 0.001), and RBC transfusion and rehospitalization within 6 months of hospital discharge decreased from 19% to 17% and 37% to 33%, respectively (P < 0.001 for both). During this period, the adjusted 6-month mortality rate decreased from 16.1% to 15.6% (P = 0.004) in patients with moderate anemia, in parallel with that of all others.

Limitation:

Possible unmeasured confounding.

Conclusion:

Anemia after hospitalization increased in parallel with decreased RBC transfusion. This increase was not accompanied by a rise in subsequent RBC use, rehospitalization, or mortality within 6 months of hospital discharge. Longitudinal analyses support the safety of practice recommendations to limit RBC transfusion and tolerate anemia during and after hospitalization.

Primary Funding Source:

National Heart, Lung, and Blood Institute.

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