title: Long-term follow-up and predictive factors of recurrence of anemia in a cohort of 102 very elderly patients explored for iron-deficiency anemia.
abstract: OBJECTIVE
  To evaluate long-term follow-up and predictors of relapse of anemia in a cohort of 102 very elderly patients previously explored for iron-deficiency anemia (IDA).
  
  
  METHODS
  One hundred and two patients [61 women and 41 men, mean age 82+/-5.8 y (75 to 98)] explored for IDA were prospectively followed up from inclusion (June 2003 to May 2005) until death or May 2006. Survival rate was estimated by the Kaplan-Meier method and compared by the log-rank test. Predictors of recurrence of anemia were identified by multivariate analysis in the 4 following subgroups: unexplained IDA (subgroup 1, n=27), benign lesion (subgroup 2, n=37), cancer treated curatively (subgroup 3, n=28), cancers treated palliatively (subgroup 4, n=10).
  
  
  RESULTS
  Median follow-up was 20 months. At baseline, main clinical and laboratory data were not significantly different in the 4 subgroups, especially as regards severe comorbidities. Thirty-three patients died, 10 (30%) of them in the first month. Ten (100%) belonged to subgroup 4 versus, respectively, n=7 (26%), n=8 (22%), and n=8 (29%) of patients from subgroups 1, 2, and 3 (P<0.001). No death was directly related to recurrence of anemia. Survival rate at 1 year was 10% in subgroup 4, significantly lower than the other 3 subgroups (subgroup 1: 84%; subgroup 2: 86%; subgroup 3: 78%; log-rank test, P<0.0001). Anemia recurred in 18 cases, and required red cell transfusion in 13 cases. Predictive factors of recurrence of anemia [odds ratio (confidence interval 95%), P] were cancers treated palliatively [14.9 (3-72), P<0.01] and angiodysplasias [4.5 (1.1-18.2), 0.035].
  
  
  CONCLUSIONS
  In a cohort of very elderly patients explored for IDA, the mortality rate and the long-term survival were not different for patients with IDA related to a cancer treated curatively than those with unexplained IDA and those with IDA related to a benign lesion. Angiodysplasias and cancers treated palliatively were associated with recurrence of anemia. These results suggest interventionist strategies (including endoscopic investigation and appropriate surgery) for elderly patients with IDA.
authors.affiliation: Service d'Hépatogastroentérologie, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France. snahon@club-internet.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nahon
authors.forename: Pierre
authors.initials: P
authors.lastname: Lahmek
authors.forename: Francine
authors.initials: F
authors.lastname: Barclay
authors.forename: Gilles
authors.initials: G
authors.lastname: Macaigne
authors.forename: Cécile
authors.initials: C
authors.lastname: Poupardin
authors.forename: Vincent
authors.initials: V
authors.lastname: Jounnaud
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delas
authors.forename: Bruno
authors.initials: B
authors.lastname: Lesgourgues
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016888:Angiodysplasia / Q000150:complications*; D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate