title: Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients.
abstract: OBJECTIVE
  This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge.
  
  
  METHODS
  A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0-11.9g/dL in women; 10.0-12.9g/dL in men) and group 3 with moderately-severely reduced Hb (<10g/dL in women and men).
  
  
  RESULTS
  Patients (2678; mean age 79.2±7.4y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR=1.62; 95%CI 1.21-2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR=1.82;95%CI 1.25-2.67; group 3: OR=2.78;95%CI 1.82-4.26) and discharge (group 2: OR=2.37;95%CI 1.48-3.93; group 3: OR=3.70;95%CI 2.14-6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes.
  
  
  CONCLUSIONS
  Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia.
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. Electronic address: emma.riva@marionegri.it.
authors.forename: Emma
authors.initials: E
authors.lastname: Riva
authors.affiliation: Medicine Intensive Care and Accident & Emergency Department, Niguarda Hospital, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Internal Medicine Unit, San Carlo Clinic, Paderno Dugnano Milan, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Moreo
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Mandelli
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Lucca
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Centre, IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Italy.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D006454:Hemoglobins
keywords: Anaemia; Clinical outcomes; Older in-patients