Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients – Results from the prospective COVIP Study

Article type: Research Article

Authors: Erkens, Ralf^a | Duse, Dragos^a | Wernly, Bernhard^b | Flaatten, Hans^c | Fjølner, Jesper^d | Bruno, Raphael Romano^a | Wolff, Georg^a | Artigas, Antonio^e | Kelm, Malte^{a; f} | Beil, Michael^g | Sviri, Sigal^g | Schaller, Stefan J.^h | Fuest, Kristinaⁱ | Szczeklik, Wojciech^j | Piayda, Kerstin^k | Elhadi, Muhammed^l | Joannidis, Michael^m | Nedergaard, Helene Korveniusⁿ | Oeyen, Sandra^o | Moreno, Rui^p | Leaver, Susannah^q | de Lange, Dylan W.^r | Guidet, Bertrand^{s; t} | Jung, Christian^a | COVIP study group

Affiliations: [a] Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany | [b] Department of Cardiology, Paracelsus Medical University, Salzburg, Austria | [c] Department of Clinical Medicine, University of Bergen, Bergen, Norway | [d] Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark | [e] Department of Intensive Care Medicine, Parc Tauli Hospital Universitari, Institut d’Investigació I Innovacio Par tauli (I3PT-CERCA), CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Barcelona, Spain | [f] CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany | [g] Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel | [h] Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charitè-Universitätsmedizin Berlin, Freie Universiätt Berlin and Humboldt-Universität zu Berlin, Berlin, Germany | [i] Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, School of Medicine, Technical University Munich, Munich, Germany | [j] Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland | [k] Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany | [l] Faculty of Medicine, University of Tripoli, Tripoli, Libya | [m] Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria | [n] Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark | [o] Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium | [p] Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitério de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal | [q] General Intensive Care, St George’s University Hospitals NHS Foundation Trust, London, UK | [r] Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands | [s] Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France | [t] Assistance Publique –Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale,, Paris, France

Correspondence: [*] Corresponding author: Christian Jung, MD, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany. Tel.: +49 211 81 18800; Fax: +49 211 81 18812; E-mail: christian.jung@med.uni-duesseldorf.de.

Abstract: Aims:Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients. Methods:In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded. Results:In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality. Conclusion:The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.

Keywords: Anaemia, transfusion, frailty, COVID-19

DOI: 10.3233/CH-231790

Journal: Clinical Hemorheology and Microcirculation, vol. 84, no. 3, pp. 309-320, 2023