Critical Care Explorations (Sep 2024)

Impact of Hemoglobin Levels on Composite Cardiac Arrest or Stroke Outcome in Patients With Respiratory Failure Due to COVID-19

  • Shi Nan Feng, BSPH,
  • Thu-Lan Kelly, PhD,
  • John F. Fraser, MD, PhD,
  • Gianluigi Li Bassi, MD, PhD,
  • Jacky Suen, PhD,
  • Akram Zaaqoq, MD, MPH,
  • Matthew J. Griffee, MD,
  • Rakesh C. Arora, MD,
  • Nicole White, PhD,
  • Glenn Whitman, MD,
  • Chiara Robba, MD, PhD,
  • Denise Battaglini, MD, PhD,
  • Sung-Min Cho, DO, MHS,
  • on behalf of COVID-19 Critical Care Consortium (CCCC),
  • Robert Bartlett,
  • John F. Fraser,
  • Gianluigi Li Bassi,
  • Jacky Y. Suen,
  • Heidi J. Dalton,
  • John Laffey,
  • Daniel Brodie,
  • Eddy Fan,
  • Antoni Torres,
  • Davide Chiumello,
  • Alyaa Elhazm,
  • Carol Hodgson,
  • Shingo Ichiba,
  • Carlos Luna,
  • Srinivas Murthy,
  • Alistair Nichol,
  • Pauline Yeung Ng,
  • Mark Ogino,
  • Aidan Burrell,
  • Antonio Pesenti,
  • Tala Al-Dabbous,
  • Huda Alfoudri,
  • Mohammed Shamsah,
  • Subbarao Elapavaluru,
  • Ashley Berg,
  • Christina Horn,
  • Yunis Mayasi,
  • Stephan Schroll,
  • Dan Meyer,
  • Jorge Velazco,
  • Ludmyla Ploskanych,
  • Wanda Fikes,
  • Rohini Bagewadi,
  • Marvin Dao,
  • Haley White,
  • Alondra Berrios Laviena,
  • Ashley Ehlers Maysoon,
  • Shalabi-McGuire,
  • Trent Witt,
  • Lorenzo Grazioli,
  • Luca Lorini,
  • E. Wilson Grandin,
  • Jose Nunez,
  • Tiago Reyes,
  • Diarmuid O’Briain,
  • Stephanie Hunter,
  • Mahesh Ramanan,
  • Julia Affleck,
  • Hemanth Hurkadli Veerendra,
  • Sumeet Rai,
  • Josie Russell-Brown,
  • Mary Nourse,
  • Mark Joseph,
  • Brook Mitchell,
  • Martha Tenzer,
  • Ryuzo Abe,
  • Hwa Jin Cho,
  • In Seok Jeong,
  • Nadeem Rahman,
  • Vivek Kakar,
  • Andres Oswaldo Razo Vazquez,
  • Nicolas Brozzi,
  • Omar Mehkri,
  • Sudhir Krishnan Abhijit,
  • Duggal Stuart Houltham,
  • Jerónimo Graf,
  • Roderigo Diaz,
  • Roderigo Orrego,
  • Camila Delgado,
  • Joyce González,
  • Maria Soledad Sanchez,
  • Michael Piagnerelli,
  • Josefa Valenzuela Sarrazin,
  • A/Prof. Gustavo Zabert,
  • Lucio Espinosa,
  • Paulo Delgado,
  • Victoria Delgado,
  • Diego Fernando,
  • Bautista Rincón,
  • Angela Maria Marulanda Yanten,
  • Melissa Bustamante Duque,
  • Daniel Brodie,
  • Alyaa Elhazmi,
  • Abdullah Al-Hudaib,
  • Maria Callahan,
  • M. Azhari Taufik,
  • Elizabeth Yasmin Wardoyo,
  • Margaretha Gunawan,
  • Nurindah S Trisnaningrum,
  • Vera Irawany,
  • Muhammad Rayhan,
  • Mauro Panigada,
  • Antonio Pesenti,
  • Alberto Zanella,
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  • Sebastiano Colombo,
  • Chiara Martinet,
  • Gaetano Florio,
  • Massimo Antonelli,
  • Simone Carelli,
  • Domenico L. Grieco,
  • Motohiro Asaki,
  • Kota Hoshino,
  • Leonardo Salazar,
  • Mary Alejandra Mendoza Monsalve,
  • John Laffey,
  • Bairbre McNicholas,
  • David Cosgrave,
  • Joseph McCaffrey,
  • Allison Bone,
  • Yusuff Hakeem,
  • James Winearls,
  • Mandy Tallott,
  • David Thomson,
  • Christel Arnold-Day,
  • Jerome Cupido,
  • Zainap Fanie,
  • Malcom Miller,
  • Lisa Seymore,
  • Dawid van Straaten,
  • Ali Ait Hssain,
  • Jeffrey Aliudin,
  • Al-Reem Alqahtani,
  • Khoulod Mohamed,
  • Ahmed Mohamed,
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  • Joy Villanueva,
  • Ahmed Zaqout,
  • Ethan Kurtzman,
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  • Anne Joosten,
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  • Minlan Yang,
  • Ana Motos,
  • Carlos Luna,
  • Francisco Arancibia,
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  • Marina Fantini,
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  • Gurmeet Singh,
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  • Aizah Lawang,
  • Josh Fine,
  • Benjamin Davidson,
  • Andres Oswaldo Razo Vazquez

DOI
https://doi.org/10.1097/CCE.0000000000001143
Journal volume & issue
Vol. 6, no. 9
p. e1143

Abstract

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OBJECTIVES:. Anemia has been associated with an increased risk of both cardiac arrest and stroke, frequent complications of COVID-19. The effect of hemoglobin level at ICU admission on a composite outcome of cardiac arrest or stroke in an international cohort of COVID-19 patients was investigated. DESIGN:. Retrospective analysis of prospectively collected database. SETTING:. A registry of COVID-19 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with cardiac arrest or stroke up to 30 days after ICU admission. Anemia was defined as: normal (hemoglobin ≥ 12.0 g/dL for women, ≥ 13.5 g/dL for men), mild (hemoglobin 10.0–11.9 g/dL for women, 10.0–13.4 g/dL for men), moderate (hemoglobin ≥ 8.0 and < 10.0 g/dL for women and men), and severe (hemoglobin < 8.0 g/dL for women and men). PATIENTS:. Patients older than 18 years with acute COVID-19 infection in the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Of 6926 patients (median age = 59 yr, male = 65%), 760 patients (11.0%) experienced stroke (2.0%) and/or cardiac arrest (9.4%). Cardiac arrest or stroke was more common in patients with low hemoglobin, occurring in 12.8% of patients with normal hemoglobin, 13.3% of patients with mild anemia, and 16.7% of patients with moderate/severe anemia. Time to stroke or cardiac arrest by anemia status was analyzed using Cox proportional hazards regression with death as a competing risk. Covariates selected through clinical knowledge were age, sex, comorbidities (diabetes, hypertension, obesity, and cardiac or neurologic conditions), pandemic era, country income, mechanical ventilation, and extracorporeal membrane oxygenation. Moderate/severe anemia was associated with a higher risk of cardiac arrest or stroke (hazard ratio, 1.32; 95% CI, 1.05–1.67). CONCLUSIONS:. In an international registry of ICU patients with COVID-19, moderate/severe anemia was associated with increased hazard of cardiac arrest or stroke.