The Association between Anemia and Mortality of Severe Pneumonia COVID-19 Patients in the High Care Unit of a Tertiary Hospital in Jakarta

Authors

  • Wulyo Rajabto Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Gurmeet Singh Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Calvin Kurnia Mulyadi Departement of Internal Medicine, Fatmawati Hospital, Jakarta, Indonesia
  • Vitya Chandika Residency program in Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Maria Pyrhadistya Research Assistant in Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Keywords:

Anemia, Mortality, Severe Pneumonia COVID-19, Chi-squared

Abstract

Background: Numerous studies explored the association between anemia and mortality in patients with severe pneumonia due to COVID-19. However, the findings were inconsistent. Therefore, this study was conducted to investigate the association between anemia at HCU admission and in-hospital mortality in severe pneumonia COVID-19 patients. Methods: This retrospective cohort study obtained data on 110 COVID-19 patients with severe pneumonia who were admitted to the HCU between January, 1st 2021, and May 31st, 2021. Patients were categorized as anemic and non-anemic based on the World Health Organization (WHO) guidelines. The demographic and clinical characteristics of the subjects were described. The Chi-squared test was carried out followed by a logistic regression test to determine the association of anemia and mortality. Results: Anemia was observed in 31% of 110 patients with severe pneumonia COVID-19. The source population consisted of 60.9% men and 39.1% women with a median age of 58 years. The most prevalent comorbidity was hypertension (38.2%), followed by diabetes mellitus (27.2%), renal diseases (19.1%) and heart diseases (10%). TAnemia on HCU admission was associated with in-hospital mortality in patients with severe pneumonia COVID-19 (RR: 2.794, 95% CI 1.470-5.312). After adjusting comorbidities as confounding factors, anemia was independently associated with mortality (RR: 2.204, 95% CI: 1.124-4.323, P < 0.021). The result also showed anemic patients had longer lengths of stay and higher levels of D-dimer than non-anemic patients. The median duration length of stay among the anemic and non-anemic was 16 (11-22) and 13 (9-17) days, respectively. The median D-dimer among the anemic and non-anemic was 2220 μg/ml and 1010 μg/ml, respectively. Conclusion: There is a significant association between anemia at HCU admission and mortality in patients with severe pneumonia COVID-19 during hospitalization.

References

Li Z, Chen Q, Feng L, et al. Active case finding with case management: the key to tackling the COVID-19 pandemic. Lancet. 2020; 396 (10243):63-70.

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.

Shang Y, Pan C, Yang X, et al. Management of critically ill patients with COVID-19 in ICU: a statement from front-line intensive care experts in Wuhan, China. Ann Intensive Care. 2020;10(1):73.

Hajjar LA, Costa IBSDS, Rizk SI, et al. Intensive care management of patients with COVID-19: a practical approach. Ann. Intensive Care. 2021;(11):36.

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed 25/9/22

World Health Organization. (‎2011)‎. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. World Health Organization. https://apps.who.int/iris/handle/10665/85839

Chen C, Zhou W, Fan W, et al. Association of anemia and COVID-19 in hospitalized patients. Future Virol. 2021:10.2217/fvl-2021-0044

Tao Z, Xu J, Chen W, et al. Anemia is associated with severe illness in COVID-19: A retrospective cohort study. J Med Virol. 2021;93(3):1478-88.

Faghih Dinevari M, Somi MH, Sadeghi Majd E, Abbasalizad Farhangi M, Nikniaz Z. Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran. BMC Infect Dis. 2021; 21:170.

Cecconi M, Piovani D, Brunetta E, et al. Early predictors of clinical deterioration in a cohort of 239 patients hospitalized for COVID-19 infection in Lombardy, Italy. J Clin Med. 2020;9(5):1548.

Oh SM, Skendelas JP, Macdonald E, et al. On-admission anemia predicts mortality in COVID-19 patients: A single-center, retrospective cohort study. Am J Emerg Med. 2021;48:140-7.

Romero Starke K, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis. BMJ Global Health 2021;6:e006434.

Helin TA, Lemponen M, Lahtiharju T, Koskinen M, Lassila R, Joutsi-Korhonen L. Anaemia and enhancement of coagulation are associated with severe COVID-19 infection. Scand J Clin Lab Invest. 2021;81(8):653-60.

Poudel A, Poudel Y, Adhikari A, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS One. 2021;16(8):e0256744.

Bergamaschi G, Borrelli de Andreis F, Aronico N, et al. Anemia in patients with COVID-19: pathogenesis and clinical significance. Clin Exp Med. 2021;21(2):239-46.

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–62.

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Published

2024-04-01

How to Cite

Rajabto, W., Singh, G., Mulyadi, C. K., Chandika, V., & Pyrhadistya, M. (2024). The Association between Anemia and Mortality of Severe Pneumonia COVID-19 Patients in the High Care Unit of a Tertiary Hospital in Jakarta. Acta Medica Indonesiana, 56(1), 63. Retrieved from https://www.actamedindones.org/index.php/ijim/article/view/2355