Incidence, Predictors, and Outcomes of Hospital-Acquired Anemia

Although hypothesized to be a hazard of hospitalization, it is unclear whether hospital-acquired anemia (HAA) is associated with increased adverse outcomes following discharge.

To examine the incidence, predictors, and postdischarge outcomes associated with HAA.

Observational cohort study using electronic health record data.

Consecutive medicine discharges between November 1, 2009 and October 30, 2010 from 6 Texas hospitals, including safety-net, teaching, and nonteaching sites. Patients with anemia on admission or missing hematocrit values at admission or discharge were excluded.

HAA was defined using the last hematocrit value prior to discharge and categorized by severity. The primary outcome was a composite of 30-day mortality and nonelective readmission.

Among 11,309 patients, one-third developed HAA (21.6% with mild HAA; 10.1% with moderate HAA; and 1.4% with severe HAA). The 2 strongest potentially modifiable predictors of developing moderate or severe HAA were length of stay (adjusted odds ratio [OR], 1.26 per day; 95% confidence interval [CI], 1.23-1.29) and receipt of a major procedure (adjusted OR, 5.09; 95% CI, 3.79-6.82). Patients without HAA had a 9.7% incidence for the composite outcome versus 16.4% for those with severe HAA. Severe HAA was independently associated with a 39% increase in the odds for 30-day readmission or death (95% CI, 1.09-1.78). Most patients with severe HAA (85%) underwent a major procedure, had a discharge diagnosis of hemorrhage, and/or a discharge diagnosis of hemorrhagic disorder.

Severe HAA is associated with increased odds for 30-day mortality and readmission after discharge; however, it is uncertain whether severe HAA is preventable. Journal of Hospital Medicine 2017;12:317-322.