Skip to main content
SpringerLink
Log in

Parameters influencing in-hospital mortality in patients hospitalized in intensive cardiac care unit: is there an influence of anemia and iron deficiency?

  • EM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

We investigated the incidence and prognostic value of anemia as well as of the iron status in non-selected patients admitted to an intensive cardiac care unit (ICCU). 392 patients (mean age 70 ± 13.8 years, 43 % women), 168 with acute coronary syndromes (ACS), 122 with acute decompensated heart failure, and 102 with other acute cardiac disorders were consecutively, prospectively assessed. The biomarkers of iron status—serum iron concentration (SIC), total iron binding capacity (TIBC), and transferrin saturation (TSAT) together with standard clinical, biochemical and echocardiographic variables—were analyzed. In-hospital mortality was 3.8 % (15 patients). The prevalences of anemia (according to WHO criteria), and iron deficiency (ID) were 64 and 63 %, respectively. The level of biomarkers of iron status, but not anemia, was lower in patients who died (p < 0.05). Anemia was less frequent in patients with ACS as compared to the remaining ICCU population (p = 0.019). The analysis by logistic regression indicated the highest risk of death for age [odds ratio (OD) 1.38, 95 % CI 1.27–1.55], SIC (OR 0.85, 95 % CI 0.78–0.94), TIBC (OR 0.95, 95 % CI 0.91–0.98), left ventricle ejection fraction (OR 0.85, 95 % CI 0.77–0.93), as well as hospitalization for non-ACS (OR 0.25, 95 % CI 0.14–0.46), (p < 0.05). The risk of death during hospitalization tended to increase with decreasing levels of TIBC (p = 0.49), as well as with the absence of ACS (p = 0.54). The incidence of anemia and ID in heterogeneous ICCU patients is high. Parameters of the iron status, but not anemia per se, independently influence in-hospital mortality. The prevalence of anemia is higher in non-ACS patients, and tends to worsen the prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J (2002) Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 39:1780–1786

    Article  PubMed  Google Scholar 

  2. Ezekowitz JA, McAlister FA, Armstrong PW (2003) Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12065 patients with new-onset heart failure. Circulation 107:223–225

    Article  PubMed  Google Scholar 

  3. Kosiborod M, Smith GL, Radford MJ, Foody JM, Krumholz HM (2003) The prognostic importance of anemia in patients with heart failure. Am J Med 114:112–119

    Article  PubMed  Google Scholar 

  4. Carmel R (2001) Anemia and aging: an overview of clinical, diagnostic and biological issues. Blood Rev 15:9–18

    Article  CAS  PubMed  Google Scholar 

  5. Andres E, Federici L, Serraj K, Kaltenbach G (2008) Update of nutrient-deficiency anemia in elderly patients. Eur J Intern Med 19:488–493

    Article  CAS  PubMed  Google Scholar 

  6. Weiss G, Goodnough LT (2005) Anemia of chronic disease. N Engl J Med 352:1011–1023

    Article  CAS  PubMed  Google Scholar 

  7. Weiss G (2009) Iron metabolism in the anemia of chronic disease. Biochim Biophys Acta 1790:682–693

    Article  CAS  PubMed  Google Scholar 

  8. Arosio P, Levi S (2002) Ferritin, iron homeostasis, and oxidative damage. Free Radic Biol Med 33:457–463

    Article  CAS  PubMed  Google Scholar 

  9. Punnonen K, Irjala K, Rajamaki A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89:1052–1057

    CAS  PubMed  Google Scholar 

  10. Mainous AG 3rd, Gill JM, Carek PJ (2004) Elevated transferrin saturation and mortality. Ann Fam Med 2:133–138

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kim KS, Son HG, Hong NS, Lee DH (2012) Associations of serum ferritin and transferrin % saturation with all-cause, cancer, and cardiovascular disease mortality: Third National Health and Nutrition Examination Survey follow-up study. J Prev Med Public Health 45:196–203

    Article  PubMed Central  PubMed  Google Scholar 

  12. Menke A, Muntner P, Fernández-Real JM, Guallar E (2012) The association of biomarkers of iron status with mortality in US adults. Nutr Metab Cardiovasc Dis 22:734–740

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Ma J, Stampfer MJ (2002) Body iron stores and coronary heart disease. Clin Chem 48:601–603

    CAS  PubMed  Google Scholar 

  14. Zegrean M (2009) Association of body iron stores with development of cardiovascular disease in the adult population: a systematic review of the literature. Can J Cardiovasc Nurs 19:26–32

    PubMed  Google Scholar 

  15. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470

    Article  CAS  PubMed  Google Scholar 

  16. Nutritional anaemias. Report of a WHO scientific group (1968). World Heath Organ Tech Rep Ser 405:5–37

  17. Jankowska EA, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, Borodulin-Nadzieja L, von Haehling S, Doehner W, Banasiak W, Polonski L, Filippatos G, Anker SD, Ponikowski P (2011) Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure. J Card Fail 17:899–906

    Article  CAS  PubMed  Google Scholar 

  18. Okonko DO, Mandal AK, Missouris CG, Poole-Wilson PA (2011) Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival. J Am Coll Cardiol 58:1241–1251

    Article  CAS  PubMed  Google Scholar 

  19. Parikh A, Natarajan S, Lipsitz SR, Katz SD (2011) Iron deficiency in community-dwelling US adults with self-reported heart failure in the National Health and Nutrition Examination Survey III: prevalence and associations with anemia and inflammation. Circ Heart Fail 4:599–606

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Cohen-Solal A, Damy T, Terbah M, Kerebel S, Baguet JP, Hanon O, Zannad F, Laperche T, Leclercq C, Concas V, Duvillié L, Darné B, Anker S, Mebazaa A (2014) High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur J Heart Fail. doi:10.1002/ejhf.139

    Google Scholar 

  21. Camaschella C, Strati P (2010) Recent advances in iron metabolism and related disorders. Intern Emerg Med 5:393–400

    Article  PubMed  Google Scholar 

  22. Liu Y, Yang YM, Zhu J, Tan HQ, Liang Y, Li JD (2012) Anaemia and prognosis in acute coronary syndromes: a systematic review and meta-analysis. J Int Med Res 40:43–55

    Article  PubMed  Google Scholar 

  23. Lawler PR, Filion KB, Dourian T, Atallah R, Garfinkle M, Eisenberg MJ (2013) Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis. Am Heart J 165(143–53):e5

    PubMed  Google Scholar 

  24. Salisbury AC, Kosiborod M, Amin AP, Reid KJ, Alexander KP, Spertus JA, Masoudi FA (2011) Recovery from hospital-acquired anemia after acute myocardial infarction and effect on outcomes. Am J Cardiol 108:949–954

    Article  PubMed Central  PubMed  Google Scholar 

  25. Aronson D, Suleiman M, Agmon Y, Suleiman A, Blich M, Kapeliovich M, Beyar R, Markiewicz W, Hammerman H (2007) Changes in haemoglobin levels during hospital course and long-term outcome after acute myocardial infarction. Eur Heart J 28:1289–1296

    Article  CAS  PubMed  Google Scholar 

  26. Miklík R, Felsöci M, Parenica J, Tomcíková D, Jarkovskỳ J, Spinar J (2010) The prevalence of anemia and its impact on hospitalization mortality in patients with acute heart failure. Vnitr Lek 56:382–391

    PubMed  Google Scholar 

  27. von Haehling S, Schefold JC, Hodoscek LM, Doehner W, Mannaa M, Anker SD, Lainscak M (2010) Anaemia is an independent predictor of death in patients hospitalized for acute heart failure. Clin Res Cardiol 99:107–113

    Article  Google Scholar 

  28. Tarantini L, Oliva F, Cantoni S, Cioffi G, Agnoletto V, Alunni G, De Cian F, Di Lenarda A, Lucci D, Pulignano G, Scelsi L, Maggioni AP, Tavazzi L (2013) Prevalence and prognostic role of anaemia in patients with acute heart failure and preserved or depressed ventricular function. Intern Emerg Med 8:147–155

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Grant supported by Medical University in Bialystok, Poland, No 123-53714L.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Medical University of Bialystok, ul. Sklodowskiej-Curie 24a, 15-276, Bialystok, Poland

    Ewa Uscinska, Bozena Sobkowicz, Robert Sawicki, Izabela Kiluk, Malgorzata Baranicz, Tomasz Stepek, Wlodzimierz J. Musial & Agnieszka M. Tycinska

  2. Department of Hematological Diagnostics, Medical University of Bialystok, Bialystok, Poland

    Milena Dabrowska

  3. Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland

    Maciej Szmitkowski

Authors
  1. Ewa Uscinska
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bozena Sobkowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Sawicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Izabela Kiluk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Malgorzata Baranicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomasz Stepek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Milena Dabrowska
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maciej Szmitkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wlodzimierz J. Musial
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Agnieszka M. Tycinska
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Agnieszka M. Tycinska.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uscinska, E., Sobkowicz, B., Sawicki, R. et al. Parameters influencing in-hospital mortality in patients hospitalized in intensive cardiac care unit: is there an influence of anemia and iron deficiency?. Intern Emerg Med 10, 337–344 (2015). https://doi.org/10.1007/s11739-014-1170-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-014-1170-8

Keywords

Search

Navigation