Severe anemia is associated with increased short-term and long-term mortality in patients hospitalized with cirrhosis

Haotang Ren; Hai Li; Guohong Deng; Xianbo Wang; Xin Zheng; Yan Huang; Jinjun Chen; Zhongji Meng; Yanhang Gao; Zhiping Qian; Feng Liu; Xiaobo Lu; Jia Shang; Shaoyang Wang; Shan Yin; Wenting Tan; Yixin Hou; Shue Xiong; Liyuan Long; Beiling Li; Sen Luo; Weituo Zhang; Yu Shi

doi:10.1016/j.aohep.2023.101147

Severe anemia is associated with increased short-term and long-term mortality in patients hospitalized with cirrhosis

Ann Hepatol. 2023 Aug 27;28(6):101147. doi: 10.1016/j.aohep.2023.101147. Online ahead of print.

Authors

Haotang Ren¹, Hai Li², Guohong Deng³, Xianbo Wang⁴, Xin Zheng⁵, Yan Huang⁶, Jinjun Chen⁷, Zhongji Meng⁸, Yanhang Gao⁹, Zhiping Qian¹⁰, Feng Liu¹¹, Xiaobo Lu¹², Jia Shang¹³, Shaoyang Wang¹⁴, Shan Yin², Wenting Tan³, Yixin Hou⁴, Shue Xiong⁵, Liyuan Long⁶, Beiling Li⁷, Sen Luo⁸, Weituo Zhang¹⁵, Yu Shi¹⁶

Affiliations

¹ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
³ Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
⁴ Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
⁵ Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China.
⁶ Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Hunan, China.
⁷ Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁸ Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Hubei, China.
⁹ Department of Hepatology, The First Hospital of Jilin University, Jilin, China.
¹⁰ Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China.
¹¹ Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China.
¹² Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
¹³ Department of Infectious Diseases, Henan Provincial People's Hospital, Henan, China.
¹⁴ Department of Infectious Diseases, Fuzhou General Hospital of Nanjing Military Command, Fujian, China.
¹⁵ Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁶ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: zjushiyu@zju.edu.cn.

PMID: 37643717
DOI: 10.1016/j.aohep.2023.101147

Abstract

Introduction and objectives: The relationship between anemia and the outcome of patients with cirrhosis is not completely clear. Therefore, we performed this large-scale epidemiological study to investigate the prevalence and severity of anemia in patients with cirrhosis and acute decompensation or liver injury and how anemia impacts short-term and long-term outcomes.

Patients and methods: Patients with cirrhosis and acute decompensation (AD) or acute liver injury (ALI) were enrolled in the Chinese AcuTe on CHronic LIver FailurE (CATCH-LIFE) studies, which consisted of two large, multicenter, prospective, observational cohorts between January 2015 and December 2016 and July 2018 and January 2019. We conducted data analysis on the prevalence of anemia and determined the relationship between anemia and prognosis.

Results: Among 1979 patients, 1389 (70.2%) had anemia, among whom 599 (41.3%) had mild anemia, 595 (15.8%) had moderate anemia and 195 (2.4%) had severe anemia. A linear association between hemoglobin level and 90-day or 1-year LT-free mortality was shown, and a 10 g/L decrease in hemoglobin level was associated with a 6.8% extra risk of 90-day death and a 5.7% extra risk of 1-year death. Severe anemia was an independent risk factor for 90-day [HR=1.649 (1.100, 2.473), p=0.016] and 1-year LT-free mortality [HR=1.610 (1.159, 2.238), p=0.005]. Multinomial logistic regression analysis further identified that severe anemia was significantly associated with post-28-day mortality but not within-28-day mortality.

Conclusions: Anemia is common in patients with cirrhosis admitted for acute events. Severe anemia was associated with poor 90-day and 1-year prognoses in these patients.

Keywords: Acute decompensation; Anemia; Cirrhosis; Liver injury; Mortality.