title: 'Sepsis-related anemia' is absent at hospital presentation; a retrospective cohort analysis.
abstract: BACKGROUND
  Anemia is a common feature during sepsis that occurs due to iatrogenic blood loss, depression of serum iron levels and erythropoietin production, and a decreased lifespan of erythrocytes. However, these mechanisms are unlikely to play a role in anemia at the start of sepsis. Moreover, sequestration of fluids, renal failure and increase of intravascular space may additionally influence the change in hemoglobin concentration during intravenous fluid administration in the acute phase of sepsis.
  
  
  METHODS
  In this retrospective study, patients who were admitted acutely to the Intensive Care Unit (ICU) were included. Patients who fulfilled the international criteria for severe sepsis or septic shock were included in the sepsis group (S-group). The remaining patients were allocated to the control group (C-group). Laboratory data from blood samples taken at first presentation to the hospital and at admission to the ICU, the amount of intravenous fluid administration and length of stay in the emergency department were collected and tested for significant differences between groups.
  
  
  RESULTS
  The difference in hemoglobin concentration between the S-group (n = 296) and C-group (n = 320) at first presentation in hospital was not significant (8.8 ± 1.2 versus 8.9 ± 1.2 mmol/l, respectively, p = 0.07). The reduction in hemoglobin concentration from the first presentation at the emergency department to ICU admission was significantly greater in the S-group compared to the C-group (1 [0.5-1.7] versus 0.5 [0.1-1.1] mmol/l, (p < 0.001)). Spearman rho correlation coefficients between the reduction in hemoglobin concentration and the amount of intravenous fluids administered or the creatinine level in the emergency department were significant (0.3 and 0.4, respectively, p < 0.001). In a multivariate regression analysis, creatinine, the amount of fluid administration and the presence of sepsis remained independently associated.
  
  
  CONCLUSIONS
  Prior to in-hospital intravenous fluid administration, there is no significant difference in hemoglobin concentration between acute septic patients and acutely ill controls. Within several hours after hospital admission, there is a significant reduction in hemoglobin concentration, not only associated with the amount of intravenous fluids administered and the creatinine level, but also independently with sepsis itself.
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands. jansma1987@gmail.com.
authors.forename: Geertje
authors.initials: G
authors.lastname: Jansma
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands. Fellery.de.Lange@ZNB.NL.
authors.forename: Fellery
authors.initials: F
authors.lastname: de Lange
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands. W.P.Kingma@ZNB.NL.
authors.forename: W Peter
authors.initials: WP
authors.lastname: Kingma
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands. namkjevellinga@hotmail.com.
authors.forename: Namkje A R
authors.initials: NA
authors.lastname: Vellinga
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands. Matty.Koopmans@ZNB.NL.
authors.forename: Matty
authors.initials: M
authors.lastname: Koopmans
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands. M.Kuiper@ZNB.NL.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands. e.boerma@chello.nl.
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Boerma
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications*; D012772:Shock, Septic / Q000150:complications*; D018709:Statistics, Nonparametric
chemical_list: D006454:Hemoglobins