Effect of Anemia on Readmission and Death in Octogenarian Patients with Lower Respiratory Tract Infections: A Retrospective Cohort Study

Yu He, Ying Chen, Kai Cao, Hui Zheng, Yu He, Ying Chen, Kai Cao, Hui Zheng

Abstract

Objectives: Lower respiratory tract infection (LRTI) in the octogenarian population is a highly prevalent disorder associated with increased mortality rates. Anemia is a common disorder in older adults and is often left untreated. We investigated whether anemia was a risk factor for LRTI-caused readmission and death in octogenarian patients.

Design: A retrospective cohort study was designed. Participants. Old patients (age: ≥80 years) hospitalized at the Department of Geriatrics to undergo treatment for LRTIs were included. A total of 215 patients (mean age: 88.73 years; 77.2% men) were studied. The patients were divided into two groups (anemia and non-anemia) based on the hemoglobin level. They were followed up for 1 year after discharge or until mortality event. The primary follow-up outcome was LRTI-caused readmission and/or death.

Results: The risk of readmission due to LTRI within 1 year of discharge was 2.308 times higher in the anemia group than the risk for the non-anemia group. The number of patients experiencing ≥2 readmissions in the anemia group was significantly higher than that in the non-anemia group (35 (23.5%) vs. 2 (3%), P < 0.001). To prevent readmission of one case, only 2.65 cases with anemia needed to be treated. Furthermore, the risk of LRTI-related deaths was 6.644 times higher in the anemia group than the risk for the non-anemia group. To prevent death of one case, only 3.9 cases with anemia needed to be treated. Statistic results revealed that hemoglobin was an independent protective factor for LRTI-caused readmission (logistic regression method, OR, 0.969; 95% CI, 0.950-0.989) and deaths (Cox regression method, β, -0.037, HR, 0.964; 95% CI, 0.934-0.994).

Conclusions: Anemia is a widely prevalent and relevant risk factor associated with LRTI-caused readmission and death within 1 year of discharge in octogenarian patients. Trial Registration. This trial is registered with NCT05355324.

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Copyright © 2022 Yu He et al.

Figures

Figure 1
Figure 1
Cohort selection.
Figure 2
Figure 2
Kaplan–Meier curves for LRTI-related mortality within 1 year of discharge.

References

    1. Collaborators G L R I. Estimates of the global regional and national morbidity mortality and aetiologies of lower respiratory. The Lancet Infectious Diseases . 2018;18
    1. Sun Y., Li H., Pei Z., et al. Incidence of community-acquired pneumonia in urban China: a national population-based study. Vaccine . 2020;38(52):8362–8370. doi: 10.1016/j.vaccine.2020.11.004.
    1. Arnold F. W., Reyes Vega A. M., Salunkhe V., et al. Older adults hospitalized for pneumonia in the United States: incidence, epidemiology, and outcomes. Journal of the American Geriatrics Society . 2020;68(5):1007–1014. doi: 10.1111/jgs.16327.
    1. Rabe K. F. W. H., Watz H. Chronic obstructive pulmonary disease. The Lancet . 2017;389(10082):1931–1940. doi: 10.1016/s0140-6736(17)31222-9.
    1. Fang L., Gao P., Bao H., et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study. The Lancet Respiratory Medicine . 2018;6(6):421–430. doi: 10.1016/s2213-2600(18)30103-6.
    1. Collaborators G. A. Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 study. BMJ . 2022;376e68208
    1. Sharma Y., Miller M., Kaambwa B., et al. Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study. BMJ Open . 2018;8(6) doi: 10.1136/bmjopen-2018-022246.e022246
    1. Zinellu E., Fois A. G., Sotgiu E., et al. Serum albumin concentrations in stable chronic obstructive pulmonary disease: a systematic review and meta-analysis. Journal of Clinical Medicine . 2021;10(2):p. 269. doi: 10.3390/jcm10020269.
    1. Bohannon R. W., Maljanian R., Ferullo J. Mortality and readmission of the elderly one year after hospitalization for pneumonia. Aging Clinical and Experimental Research . 2004;16(1):22–25. doi: 10.1007/bf03324527.
    1. Buja A., De Polo A., De Battisti E., et al. The importance of sex as a risk factor for hospital readmissions due to pulmonary diseases. BMC Public Health . 2020;20(1):p. 53. doi: 10.1186/s12889-019-8138-6.
    1. Cabré M., Serra-Prat M., Force L., Almirall J., Palomera E., Clave P. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study. The journals of gerontology. Series A, Biological sciences and medical sciences . 2014;69(3):330–337. doi: 10.1093/gerona/glt099.
    1. Stauder R., Valent P., Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood . 2018;131(5):505–514. doi: 10.1182/blood-2017-07-746446.
    1. Wang Y., Ping Y. J., Jin H. Y., Ge N., Wu C. Prevalence and health correlates of anaemia among community-dwelling Chinese older adults: the China health and retirement longitudinal study. BMJ Open . 2020;10(10) doi: 10.1136/bmjopen-2020-038147.e038147
    1. von Elm E., Altman D. G., Egger M., Pocock S. J., Gotzsche P. C., Vandenbroucke J. P. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ . 2007;335
    1. PRC M O H O. WS/T 405-2012 Reference Intervals For Blood Cell Analysis . Beijing, China: Standards Press of China; 2012.
    1. Freburger J. K., Chou A., Euloth T., Matcho B. Variation in acute care rehabilitation and 30-day hospital readmission or mortality in adult patients with pneumonia. JAMA Network Open . 2020;3(9) doi: 10.1001/jamanetworkopen.2020.12979.e2012979
    1. Faverio P., Compagnoni M. M., Della Zoppa M., et al. Rehospitalization for pneumonia after first pneumonia admission: incidence and predictors in a population-based cohort study. PLoS One . 2020;15(6) doi: 10.1371/journal.pone.0235468.e0235468
    1. Graversen S. B., Pedersen H. S., Sandbaek A., Foss C. H., Ribe A. R. Factors associated with 30-day rehospitalization and mortality in older patients after a pneumonia admission. Journal of the American Medical Directors Association . 2020;21(12):1869–1878.e10. doi: 10.1016/j.jamda.2020.08.025.
    1. Hamadi H. Y., Martinez D., Xu J., et al. Effects of post-discharge telemonitoring on 30-day chronic obstructive pulmonary disease readmissions and mortality. Journal of Telemedicine and Telecare . 2020:1357633X20970402–20970402X. doi: 10.1177/1357633x20970402.
    1. Ekerstad N., Bylin K., Karlson B. W. Early rehospitalizations of frail elderly patients the role of medications: a clinical, prospective, observational trial. Drug, Healthcare and Patient Safety . 2017;9:77–88. doi: 10.2147/dhps.s139237.
    1. Shin B., Kim S. H., Yong S. J., et al. Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia. Chronic Respiratory Disease . 2018;16 doi: 10.1177/1479972318809480.147997231880948
    1. Kundi H., Wadhera R. K., Strom J. B., et al. Association of frailty with 30-day outcomes for acute myocardial infarction, heart failure, and pneumonia among elderly adults. JAMA Cardiology . 2019;4(11):p. 1084. doi: 10.1001/jamacardio.2019.3511.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren