Acute and Critical Care

Original Article

Infection
Relationship between low hemoglobin levels and mortality in patients with septic shock: Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):141-147. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00465

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Background
Hemoglobin levels are a critical parameter for oxygen delivery in patients with shock. On comparing target hemoglobin levels upon transfusion initiation, the correlation between the severity of decrease in hemoglobin levels and patient outcomes remains unclear. We evaluated the association between initial hemoglobin levels and mortality in patients with septic shock treated with protocol-driven resuscitation bundle therapy at an emergency department.
Methods
Data of adult patients diagnosed with septic shock between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Patients were classified into four groups according to initial hemoglobin levels: ≥9.0 g/dl, 8.0−8.9 g/dl, 7.0−7.9 g/dl, and <7.0 g/dl. The primary endpoint was 90-day mortality.
Results
In total, 2,265 patients (male, 58.3%; median age, 70.0 years [interquartile range, 60 to 78 years]) with septic shock were included. For the four groups, 90-day mortality rates were as follows: 29.1%, 43.0%, 46.5%, and 46.9% for ≥9.0 g/dl (n=1,808), 8.0−8.9 g/dl (n=217), 7.0−7.9 g/dl (n=135), and <7.0 g/dl (n=105), respectively (P<0.001). Multivariate logistic regression showed that initial hemoglobin levels were an independent factor associated with 90-day mortality and mortality proportionally increased with decreasing hemoglobin levels (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.36 to 2.61 for 8.0−8.9 g/dl; OR, 1.97; 95% CI, 1.31 to 2.95 for 7.0–7.9 g/dl; and OR, 2.35; 95% CI, 1.52 to 3.63 for <7.0 g/dl).
Conclusions
Low hemoglobin levels (<9.0 g/dl) were observed in approximately 20% of patients with septic shock, and the severity of decrease in these levels correlated with mortality.

Citations

Citations to this article as recorded by

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Case Reports

The Care of a Jehovah's Witness with Life-threatening Anemia Refusing Ventilator Care: A Case Report: Ji Hyeon Lee, So Ron Choi, Young Jhoon Chin, Soo Il Lee, Chan Jong Chung, Jong Hwan Lee, Seung Cheol Lee; Korean J Crit Care Med. 2010;25(1):52-55.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.52

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Abstract PDF: Jehovah's Witnesses refuse the transfusion of blood and blood products, even when it can be lifesaving. Their religious conviction against receiving blood can create a difficult clinical dilemma, particularly in the life threatening situations. We report a case of a 42-year-old female Jehovah's Witness patient who had life-threatening anemia after postpartum hemorrhage. Despite severe anemia, she had a good postoperative recovery without complications.

The Effect of Hemodilution Treatment for Patient with Hemorrhagic Cerebral Venous Thrombosis due to Iron Deficiency Anemia: A Case Report: Mi Hye Lim, Sun Young Oh, Young Hyun Kim, Byoung Soo Shin; Korean J Crit Care Med. 2009;24(1):47-50.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.47

2,385 View
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Abstract PDF: Cerebral venous sinus thrombosis (CVT) is a rare disease that's associated with a wide variety of clinical signs and symptoms, and CVT is a potentially lethal condition. Iron deficiency anemia (IDA) as the cause of an adult case of CVT is very rare. We report here on a patient with CVT with intracerebral hemorrhage that was caused by IDA, and the patient was treated with hemodilution. We suggest that hemodilution should be considered as another therapeutic option for CVT with cerebral hemorrhage in a patient suffering with IDA.

Hemolytic Uremic Syndrome Occurred after Esophagectomy: A Case Report: Su Hyeon Park, Sung Tae Jeong, Seok Jai Kim, Hong Beom Bae, Sung Su Chung, Sang Hyun Kwak; Korean J Crit Care Med. 2007;22(1):42-47.

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Abstract PDF: Hemolytic uremic syndrome is an unusual and uncommon disease in adults but more common in children, which is defined by the triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. We report a 64-year-old man who developed hemolytic uremic syndrome after esophagectomy and esophagogastrostomy due to esophageal cancer. We treated him using continuous renal replacement therapy and plasmapheresis with large volume fresh frozen plasma transfusion for 9 days. We could not find the cause of hemolytic uremic syndrome, and so finally concluded that it is idiopathic. Bleeding continuously without a particular reason after an operation, it needs an early diagnosis and treatment with considering a possibility of the hemolytic uremic syndrome.

A Case of Severe Anemia Due to Anti Ce in Transfused Patient: Young Jae Kim, Kun Moo Lee, Soon Ho Jeong, Young Kyun Choe, Jin Woo Park, Chee Mahn Shin, Ju Yuel Park; Korean J Crit Care Med. 1998;13(1):101-104.

1,393 View
126 Download

Abstract PDF: Intraoperative massive bleeding requires fluid therapy and blood transfusion. But transfusion may elicit infection, hemolytic reaction, hemostatic disorder and other complication. Individuals often produce antibodies to the alleles which lack in ABO and Rh system. Such antibodies are responsible for the most serious reaction to transfusions. Antibodies may occur "naturally" or in response to sensitization from a previous transfusion or pregnancy. We report a case of severe anemic patient who had Anti Ce due to previous transfusion and was not transfused for several hours because of incompatible cross-matching. His Rh phenotype is revealed cDE.

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