Analysis of the structure of comorbidity in patients with severe anemia


DOI: https://dx.doi.org/10.18565/therapy.2024.8.30-38

Markus E.A., Korobeynikova A.N.

1) Central City Hospital No. 20, Yekaterinburg; 2) Center for Cardiology and Neurology, Kirov
Abstract. According to 2021 data, every fourth citizen of the world suffered from anemia. Anemia is a polyetiological condition making worse the course of other diseases, especially in comorbid patients. However, at the moment, correlation between anemia and comorbidity has not been fully studied.
The aim: to analyze the structure of comorbidity in patients with severe anemia (SA).
Material and methods. Retrospective continuous study was performed on the basis of therapeutic department of Central City Hospital No. 20, Yekaterinburg. Socio-demographic characteristics, diagnosis, laboratory and instrumental examinations and treatment of 105 inpatients (41% female patients) were analyzed. The inclusion criteria for the study were age over 18 years and “severe chronic anemia” diagnosis.
Results. The average age of patients was 62 ± 15.2 years old. In 89.5% of cases, patients were referred to the hospital by an outpatient institution, the rest applied for help on their own. The main causes of anemia were oncological (30.5%), gastroenterological (19.0%), gynecological diseases (11.4%). In a third of patients, the etiology of SA remained unknown. Studied individuals had from 0 to 12 chronic non-infectious pathologies. According to the Charlson index, 22.9% of patients had a 96–98% probability of 10-year survival, the minimum level of this index was (0%) in 2.9% of surveyed. According to CIRS-G scale, 89.5% of participants had a comorbidity score of 6, which reflects a severe health condition. The average levels of Charlson and CIRS-G indexes in patients with SA associated malignant neoplasm were significantly higher than among patients with SA associated with other diseases.
Conclusion. Understanding the structure of comorbid pathology in SA patients will help to develop an individual approach to them which will allow to treat both the main and concomitant diseases, as well as reduce mortality rate and the number of hospitalizations.
Keywords: comorbidity, blood transfusion, anemia
Read entire article

Literature

1. Kassebaum N.J. The global burden of anemia. Hematol Oncol Clin North Am. 2016; 30(2): 247–308.


https://doi.org/10.1016/j.hoc.2015.11.002. PMID: 27040955.


2. GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: Findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023; 10(9): e713–e734.


https://doi.org/10.1016/S2352-3026(23)00160-6. PMID: 37536353. PMCID: PMC10465717.


3. Brabin B.J., Hakimi M., Pelletier D. An analysis of anemia and pregnancy-related maternal mortality. J Nutr. 2001; 131(2S-2): 604S–614S; discussion 614S–615S.


https://doi.org/10.1093/jn/131.2.604S. PMID: 11160593.


4. Sachdev H., Gera T., Nestel P. Effect of iron supplementation on mental and motor development in children: Systematic review of randomised controlled trials. Public Health Nutr. 2005; 8(2): 117–32.


https://doi.org/10.1079/PHN2004677. PMID: 15877905.


5. Anand I.S. Anemia and chronic heart failure implications and treatment options. J Am Coll Cardiol. 2008; 52(7): 501–11.


https://doi.org/10.1016/j.jacc.2008.04.044. PMID: 18687241.


6. Musallam K.M., Tamim H.M., Richards T. et al. Preoperative anemia and postoperative outcomes in non-cardiac surgery: A retrospective cohort study. Lancet. 2011; 378(9800): 1396–407.


https://doi.org/10.1016/S0140-6736(11)61381-0. PMID: 21982521.


7. Martinsson A., Andersson C., Andell P. et al. Anemia in the general population: Prevalence, clinical correlates and prognostic impact. Eur J Epidemiol. 2014; 29(7): 489–98.


https://doi.org/10.1007/s10654-014-9929-9. PMID: 24952166.


8. Shander A., Hardy J.F., Ozawa S. et al.; Collaborators. A global definition of patient blood management. Anesth Analg. 2022; 135(3): 476–88.


https://doi.org/10.1213/ANE.0000000000005873. PMID: 35147598.


9. Warner M.A., Goobie S.M. Preoperative anemia screening and treatment: Is it worth the return on investment? Anesth Analg. 2021; 132(2): 341–43.


https://doi.org/10.1213/ANE.0000000000005313. PMID: 33449557. PMCID: PMC8054223.


10. Lasocki S., Asfar P., Jaber S. et al. Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: A multicenter, randomized, single-blinded trial. Crit Care. 2021; 25(1): 62.


https://doi.org/10.1186/s13054-020-03430-3. PMID: 33588893. PMCID: PMC7885380.


11. Pasricha S.R., Tye-Din J., Muckenthaler M.U., Swinkels D.W. Iron deficiency. Lancet. 2021; 397(10270): 233–48.


https://doi.org/10.1016/S0140-6736(20)32594-0. PMID: 3328513.


12. Krishnasivam D., Trentino K.M., Burrows S. et al. Anemia in hospitalized patients: An overlooked risk in medical care. Transfusion. 2018; 58(11): 2522–28.


https://doi.org/10.1111/trf.14877. PMID: 30276822.


13. Vogeli C., Shields A.E., Lee T.A. et al. Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007; 22 Suppl 3(Suppl 3): 391–95.


https://doi.org/10.1007/s11606-007-0322-1. PMID: 18026807. PMCID: PMC2150598.


14. Marengoni A., Angleman S., Melis R. et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev. 2011; 10(4): 430–39.


https://doi.org/10.1016/j.arr.2011.03.003. PMID: 21402176.


15. Read J.R., Sharpe L., Modini M. et al. Multimorbidity and depression: A systematic review and meta-analysis. J Affect Disord. 2017; 221: 36–46.


https://doi.org/10.1016/j.jad.2017.06.009. PMID: 28628766.


16. Bower P., Macdonald W., Harkness E. et al. Multimorbidity, service organization and clinical decision making in primary care: A qualitative study. Fam Pract. 2011; 28(5): 579–87.


https://doi.org/10.1093/fampra/cmr018. PMID: 21613378.


17. Smith S.M., O’Kelly S., O’Dowd T. GPs’ and pharmacists’ experiences of managing multimorbidity: A “Pandora’s box”. Br J Gen Pract. 2010; 60(576): 285–94.


https://doi.org/10.3399/bjgp10X514756. PMID: 20594430. PMCID: PMC2894403.


18. Nguyen H., Manolova G., Daskalopoulou C. et al. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. J Comorb. 2019; 9: 2235042X19870934.


https://doi.org/10.1177/2235042X19870934. PMID: 31489279. PMCID: PMC6710708.


19. Hien H., Berthé A., Drabo M.K. et al. Prevalence and patterns of multimorbidity among the elderly in Burkina Faso: Cross-sectional study. Trop Med Int Health. 2014; 19(11): 1328–33.


https://doi.org/10.1111/tmi.12377. PMID: 25164626.


20. Vadrevu L., Kumar V., Kanjilal B. Rising challenge of multiple morbidities among the rural poor in India – a case of the Sundarbans in West Bengal. Int J Med Sci Public Health. 2016: 5(5): 1–8.


https://doi.org/ijmsph.2016.25082015129.


21. Charlson M.E., Pompei P., Ales K.L. et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987; 40(5): 373–83.


https://doi.org/10.1016/0021-9681(87)90171-8. PMID: 3558716.


22. Miller M.D., Paradis C.F., Houck P.R. et al. Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992; 41(3): 237–48.


https://doi.org/10.1016/0165-1781(92)90005-n. PMID: 1594710.


23. Николаев Ю.А., Севостьянова Е.В., Митрофанов И.М. с соавт. Особенности полиморбидности у пациентов терапевтической клиники кардиологического и гастроэнтерологического профиля. Терапевтический архив. 2016; (1): 40–45. (Nikolaev Yu.A., Sevostyanova E.V., Mitrofanov I.M. et al. Features of polymorbidity in cardiac and gastroenterologic patients from a therapeutic clinic. Therapevticheskiy arkhiv = Therapeutic Archive. 2016; 88(1): 40–45 (In Russ.)).


https://doi.org/10.17116/terarkh201688140-45. EDN: VKWGYL.


24. Ahmadi B., Alimohammadian M., Yaseri M. et al. Multimorbidity: Epidemiology and risk actors in the Golestan cohort study, Iran: A cross-sectional analysis. Medicine (Baltimore). 2016; 95(7): e2756.


https://doi.org/10.1097/MD.0000000000002756. PMID: 26886618. PMCID: PMC4998618.


25. Barnett K., Mercer S.W., Norbury M. et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836): 37–43.


https://doi.org/10.1016/S0140-6736(12)60240-2. PMID: 22579043.


26. Lefevre T., d’Ivernois J.F., De Andrade V. et al. What do we mean by multimorbidity? An analysis of the literature on multimorbidity measures, associated factors, and impact on health services organization. Rev Epidemiol Sante Publique. 2014; 62(5): 305–14.


https://doi.org/10.1016/j.respe.2014.09.002. PMID: 25444838.


27. Nunes B.P., Flores T.R., Mielke G.I. et al. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2016; 67: 130–38.


https://doi.org/10.1016/j.archger.2016.07.008. PMID: 27500661.


28. BD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258): 1204–22.


https://doi.org/10.1016/S0140-6736(20)30925-9. PMID: 33069326. PMCID: PMC7567026.


29. Ryan B.L., Bray Jenkyn K., Shariff S.Z. et al. Beyond the grey tsunami: A cross-sectional population-based study of multimorbidity in Ontario. Can J Public Health. 2018; 109(5–6): 845–54.


https://doi.org/10.17269/s41997-018-0103-0. PMID: 30022403. PMCID: PMC6964436.


30. van Oostrom S.H., Picavet H.S., de Bruin S.R. et al. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Fam Pract. 2014; 15: 61.


https://doi.org/10.1186/1471-2296-15-61. PMID: 24708798. PMCID: PMC4021063.


31. Sinnott C., Mc Hugh S., Browne J., Bradley C. GPs’ perspectives on the management of patients with multimorbidity: Systematic review and synthesis of qualitative research. BMJ Open. 2013; 3(9): e003610.


https://doi.org/10.1136/bmjopen-2013-003610. PMID: 24038011. PMCID: PMC3773648.


32. Yilmaz G., Shaikh H. normochromic normocytic anemia. 2023. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2024.


33. Снеговой А.В., Aapro M., Давиденко И.С. с соавт. Практические рекомендации по лечению анемии у онкологических больных. Злокачественные опухоли. 2015; 4(С): 316–326. (Snegovoy A.V., Aapro M., Davidenko I.S. et al. Practical recommendations for the treatment of anemia in cancer patients. Zlokachestvennye opukholi = Malignant Tumoursis. 2015; 4(С): 316–326 (In Russ.)).


https://doi.org/10.18027/2224-5057-2015-4s-316-326.


34. Ponikowski P., van Veldhuisen D.J., Comin-Colet J. et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2015; 36(11): 657–68.


https://doi.org/10.1093/eurheartj/ehu385. PMID: 25176939. PMCID: PMC4359359.


35. O’Meara E., Clayton T., McEntegart M.В. et al. Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: Results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation. 2006; 113(7): 986–94.


https://doi.org/10.1161/circulationaha.105.582577. PMID: 16476847.


36. Mozaffarian D., Nye R., Levy W.C. Anemia predicts mortality in severe heart failure: The prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol. 2003; 41(11): 1933–39.


https://doi.org/10.1016/s0735-1097(03)00425-x. PMID: 12798560.


37. Мартынов С.А., Шестакова М.В., Шилов Е.М. с соавт. Распространенность анемии у больных сахарным диабетом 1 и 2 типа с поражением почек. Сахарный диабет. 2017; 20(5): 318–328. (Martynov S.A., Shestakova M.V., Shilov E.M. et al. Prevalence of anemia in patients with type 1 and type 2 diabetes mellitus with chronic renal disease. Saharnyy diabet = Diabetes Mellitus. 2017; 20(5): 318–328 (In Russ.)).


https://doi.org/10.14341/DM9369. EDN: ZWJOMH.


38. Thomas M.C., MacIsaac R.J., Tsalamandris C. et al. Anemia in patients with type 1 diabetes. J Clin Endocrinol Metab. 2004; 89(9): 4359–63.


https://doi.org/10.1210/jc.2004-0678. PMID: 15356033.


39. Thomas M.C., MacIsaac R.J., Tsalamandris C. et al. The burden of anemia in type 2 diabetes and role of nephropathy: A crosssectional audit. Nephrol Dial Transplant. 2004; 19(7): 1792–97.


https://doi.org/10.1093/ndt/gfh248. PMID: 15102962.


40. Camargo J.L., Gross J.L. Conditions associated with very low values of glycohaemoglobin measured by an HPLC method. J Clin Pathol. 2004; 57(4): 346–49.


https://doi.org/10.1136/jcp.2002.007088. PMID: 15047733. PMCID: PMC1770269.


41. Hazin M.A.A. Anemia in chronic kidney disease. Rev Assoc Med Bras. 2020; 66(Suppl 1): s55–s58.


https://doi.org/10.1590/1806-9282.66.S1.55. PMID: 31939536.


42. Айтбаев К.А., Муркамилов И.Т., Фомин В.В. с соавт. Нефрогенная анемия: прогресс в понимании патофизиологии и потенциал новых подходов к безопасной терапии. Клиническая лабораторная диагностика. 2017; 62(12): 735–741. (Aitbaev K.A., Murkamilov I.T., Fomin V.V. et al. The nephrogenic anemia: Progression in comprehension of pathophysiology and a potential of the new approaches to safe therapy. Klinicheskaya laboratornaya diagnostika = Russian Clinical Laboratory Diagnostics. 2017; 62(12): 735–741 (In Russ.)).


https://doi.org/10.18821/0869-2084. EDN: YMRWSY.


43. van Haalen H., Jackson J., Spinowitz B. et al. Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: Analysis of multinational real-world data. BMC Nephrol. 2020; 21(1): 88.


https://doi.org/10.1186/s12882-020-01746-4. PMID: 32143582. PMCID: PMC7060645.


44. Маматова М.Б., Джумабаева С.Э., Джумабаев Э.С. с соавт. Изучение тяжести коморбидности у женщин с анемиями. Экономика и социум. 2022; (3–1): 323–326. (Mamatova M.B., Dzhumabaeva S.E., Dzhumabaev E.S. et al. Studying the severity of comorbidity in women with anemia. Ekonomika i sotsium = Economics and Society. 2022; (3–1): 323–326 (In Russ.)). EDN: YYGMFG.


45. Amano S., Ohta R., Sano C. Relationship between anemia and readmission among older patients in Rural Community Hospitals: A retrospective cohort study. J Clin Med. 2024; 13(2): 539.


https://doi.org/10.3390/jcm13020539. PMID: 38256673. PMCID: PMC10816581.


46. Salis F., Locci G., Mura B., Mandas A. et al. Anemia in elderly patients – the impact of hemoglobin cut-off levels on geriatric domains. Diagnostics (Basel). 2023; 13(2): 191.


https://doi.org/10.3390/diagnostics13020191. PMID: 36673001. PMCID: PMC9857598.


About the Autors

Emilia A. Markus, MD, general practitioner of the Admissions Department, Central City Hospital No. 20, Yekaterinburg. Address: 620010, Yekaterinburg, 3 Dagestanskaya St.
E-mail: markus-em@rambler.ru
ORCID: https://orcid.org/0009-0003-2915-5786
Anna N. Korobeynikova, MD, PhD (Medicine), cardiologist at Center for Cardiology and Neurology, Kirov. Address: 610014, Kirov, 41 Ivana Popova St.
E-mail: anna_best2004@mail.ru
ORCID: https://orcid.org/0000-0002-4357-1757


Similar Articles

Back to Content

Бионика Медиа