title: Impact of anemia on outcome in critically ill patients with severe acute renal failure.
abstract: OBJECTIVE
  To evaluate the prognostic value of hemoglobin levels in critically ill patients with acute renal failure (ARF) requiring dialysis.
  
  
  METHODS
  A prospective observational cohort study in two adult medical ICUs.
  
  
  METHODS
  206 consecutive patients with ARF who required dialysis. Overall 28-day mortality was 48%.
  
  
  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.
authors.affiliation: Department of Medical Intensive Care, Caen University Hospital, Av côte de Nacre, 14033, Caen Cedex, France. ducheyron-d@chu-caen.fr
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fekih-Hassen
authors.forename: Cédric
authors.initials: C
authors.lastname: Daubin
authors.forename: Pierre
authors.initials: P
authors.lastname: Charbonneau
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000740:Anemia / Q000150:complications / Q000628:therapy*; D016638:Critical Illness; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D006435:Renal Dialysis; D015996:Survival Rate
chemical_list: D006454:Hemoglobins