Anemia in hospitalized patients: an overlooked risk in medical care.

BACKGROUND: This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS: A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in-hospital mortality and LOS. RESULTS: Of 80,765 inpatients, 45,675 (56.55%) had anemia during admission. Mild and moderate/severe anemia were independently associated with increased in-hospital mortality (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.36-1.86, p = 0.001; OR 2.77, 95% CI 2.32-3.30, p < 0.001, respectively). Anemia was also associated with increased LOS, demonstrating a larger effect in emergency (mild anemia-incident rate ratio [IRR] 1.52, 95% CI 1.48-1.56, p < 0.001; moderate/severe anemia-IRR 2.18, 95% CI 2.11-2.26, p < 0.001) compared to elective admissions (mild anemia-IRR 1.30, 95% CI 1.21-1.41, p < 0.001; moderate/severe anemia-IRR 1.69, 95% CI 1.55-1.83, p < 0.001). LOS was longer in patients who developed anemia during admission compared to those who had anemia on admission (IRR 1.13, 95% CI 1.10-1.17, p < 0.001). Red cell transfusion was independently associated with 2.23 times higher odds of in-hospital mortality (95% CI 1.89-2.64, p < 0.001) and 1.31 times longer LOS (95% CI 1.25-1.37, p < 0.001). CONCLUSION: More than one-third of patients not anemic on admission developed anemia during admission. Even mild anemia is independently associated with increased mortality and LOS; however, transfusion to treat anemia is an independent and additive risk factor.

Limited referral to nephrologists from a tertiary geriatric outpatient clinic despite a high prevalence of chronic kidney disease and anaemia.

BACKGROUND: Chronic kidney disease (CKD) is increasing in prevalence world-wide with the largest growth being in the elderly. The aim of this study was to examine the prevalence of CKD in a geriatric outpatient clinic within a tertiary hospital and its association with anaemia and mortality with a focus on the referral patterns towards nephrologists. METHODS: Retrospective study utilising administrative databases. The cohort was defined as all patients that attended the geriatric outpatient clinics of a single tertiary hospital within the first 3 months of 2006. Patients were followed for 18 months for mortality and referral to a nephrologist. RESULTS: The mean Glomerular filtration rate (eGFR) of the 439 patients was 67.4 ± 29.1 mL/min/1.73 m² (44% <60 mL/min/1.73 m²). 11.8% had a haemoglobin < 110 g/L, with anaemia being significantly associated with kidney function in those with a eGFR < 60 mL/min/1.73 m² (p = 0.0092). Kidney function and anaemia were significantly associated with mortality on multivariate analysis (p = 0.019 and p = 0.0074). After 18 months, 8.8% of patients with CKD were referred to a nephrologist. CONCLUSION: Despite a high prevalence of CKD in patients attending a geriatric outpatient clinic and its association with anaemia and mortality, few of these patients were referred to a nephrologist. An examination of the reasons behind this bias is required.

The Relationship Between Presentation and the Time of Initial Administration of Antibiotics With Outcomes of Peritonitis in Peritoneal Dialysis Patients: The PROMPT Study.

INTRODUCTION: The impact of time to treatment on clinical outcome is an established precept in infectious disease but is not established in peritoneal dialysis-related peritonitis (PDRP). METHODS: In a prospective multicenter study of PDRP, symptom-to-contact time (SC), contact-to-treatment time (CT), defined as the time from health care presentation to initial antibiotic, and symptom-to-treatment time (ST) were determined. RESULTS: One hundred sixteen patients had 159 episodes of PDRP. Median SC for all episodes was 5.0 hours (first to third quartile [Q1-Q3]: 1.3-13.9); CT, 2.3 hours (Q1-Q3: 1.2-4.0); and ST, 9.0 hours (Q1-Q3: 4.7-25.3). Thirty-eight (23.9%) patient episodes (28 catheter removals and 10 deaths) met the primary composite outcome of PD failure at 30 days (PD-fail). The risk of PD-fail increased by 5.5% for each hour of delay of administration of antibiotics (odds ratio [OR] for CT: 1.055; 95% confidence interval [CI]: 1.005-1.109; P = 0.032). Neither SC (OR: 1.00; 95% CI: 0.99-1.01; P = 0.74) nor ST (OR: 1.00; 95% CI: 0.99-1.01; P = 0.48) was associated with PD-fail. In a multivariable analysis, only CT for presentation to a hospital-based facility compared with a community facility (OR: 1.068; 95% CI: 1.013-1.126; P = 0.015) and female sex (OR: 2.4; 95% CI: 1.1-5.4; P = 0.027) were independently associated with PD-fail. Each hour of delay in administering antibacterial therapy from the time of presentation to a hospital facility increased the risk of PD failure or death by 6.8%. DISCUSSION: Strategies targeted to expedited antibiotic treatment should be implemented to improve outcomes from PDRP.