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Impact of anemia on outcome in critically ill patients with severe acute renal failure

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Abstract

Objective

To evaluate the prognostic value of hemoglobin levels in critically ill patients with acute renal failure (ARF) requiring dialysis.

Design and setting

A prospective observational cohort study in two adult medical ICUs.

Patients

206 consecutive patients with ARF who required dialysis. Overall 28-day mortality was 48%.

Measurements and results

At ICU admission mean hemoglobin level was 9.1±2.1 g/dl. By ROC curve analysis the threshold value of hemoglobin with the highest sensibility/specificity was 9 g/dl. At baseline 63% of patients had anemia, defined as initial hemoglobin below 9 g/dl. Kaplan-Meier analysis showed that these patients had lower survival rate than those with hemoglobin above 9 g/dl. By multivariable analysis three factors were independently associated with 28-day death: hemoglobin lower than 9 g/dl (adjusted odds ratio 2.4, 95% CI 1.1–5.2), age, and SOFA score. Based on age and SOFA a matched cohort analysis of 67 pairs of ARF patients with or without anemia found similar results regarding the negative impact of anemia on outcome. Finally, a multivariable logistic regression analysis on matched cohort identified hemoglobin level below 9 g/dl (adjusted odds ratio 1.32, 95%CI 1.15–1.46), continuous renal replacement therapy, and vasoactive therapy as independent predictors of 28-day death.

Conclusions

These results suggest that initial hemoglobin level could be helpful in identifying patients with ARF requiring dialysis at high risk of death.

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Acknowledgements

We thank Drs. William Marie, Anne Lesage, Abdel Ouchikhe, Michel Ramakers, Virginie Verrier, and Sophie Vincent for their contribution in the management of patients.

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Authors and Affiliations

  1. Department of Medical Intensive Care, Caen University Hospital, Av côte de Nacre, 14033, Caen Cedex, France

    Damien du Cheyron, Jean-Jacques Parienti, Mohamed Fekih-Hassen, Cédric Daubin & Pierre Charbonneau

  2. Department of Infectious Diseases, Caen University Hospital, Av côte de Nacre, 14033, Caen Cedex, France

    Jean-Jacques Parienti

Authors
  1. Damien du Cheyron
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  2. Jean-Jacques Parienti
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  3. Mohamed Fekih-Hassen
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  4. Cédric Daubin
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  5. Pierre Charbonneau
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Corresponding author

Correspondence to Damien du Cheyron.

Additional information

This article refers to the editorial http://dx.doi.org/10.1007/s00134-005-2738-6

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du Cheyron, D., Parienti, JJ., Fekih-Hassen, M. et al. Impact of anemia on outcome in critically ill patients with severe acute renal failure. Intensive Care Med 31, 1529–1536 (2005). https://doi.org/10.1007/s00134-005-2739-5

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  • DOI: https://doi.org/10.1007/s00134-005-2739-5

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