Anemia intrahospitalaria y descenso de hemoglobina en pacientes internados / Hospital-acquired anemia and decrease of hemoglobin levels in hospitalized patients

RESUMEN

Es frecuente observar el desarrollo de anemia durante la internación, especialmente en pacientes graves. Esto se ha relacionado a extracciones de laboratorio. Pocos estudios evaluaron su prevalencia y factores asociados en pacientes internados en sala general. El objetivo fue determinar la prevalencia, características y factores clínicos asociados a anemia intrahospitalaria y descenso de hemoglobina en pacientes internados. Se efectuó un estudio transversal, prospectivo, descriptivo. Se analizaron 192 internaciones consecutivas en sala general. Se determinó aquellas que presentaron un descenso del valor de hemoglobina = 2 g/dl y se analizaron factores de riesgo asociados. Presentaron anemia 139 pacientes (72.4%), 89 (46.4%) al ingreso y 50 (26%) durante la internación. Se presentaron 47 casos de descenso de hemoglobina = 2 g/dl (24.47%), en los que se observaron los valores más bajos de hematocrito y hemoglobina al alta (p = 0.01), hidratación parenteral con mayor volumen (p = 0.01) y estadías hospitalarias más prolongadas (p = 0.0001). En el análisis univariado las variables leucocitosis = 11 000mm³ (OR; IC95% 2.02; 1.03-4; p = 0.01), días de internación = 7 (OR; IC95% 3.39; 1.62-7.09; p = 0.0006), hidratación parenteral = 1500 ml/día (OR; IC95% 2.47; 1.06-6.4; p = 0.01), vía central (OR; IC95% 10.29; 1.75-108.07, p = 0.003) y anemia intrahospitalaria (OR; IC95% 7.06; 3.41-15.83; p = 0.00000004) fueron estadísticamente significativos como factores de riesgo para descenso de hemoglobina = 2 g/dl. En el análisis multivariado las variables leucocitosis = 11 000 mm³ (OR; IC95%2.45; 1.14-5.27; p = 0.02); días de internación = 7 (OR; IC95% 5.15; 2.19-12.07; p = 0.0002); hidratación parenteral = 1500 ml/día (OR; IC95% 2.95; 1.13-7.72; p = 0.02) y vía central (OR; IC95%8.82; 1.37-56.82; p = 0.02) fueron factores predictivos independientes de descenso de hemoglobina = 2 g/dl. La anemia intrahospitalaria tuvo una elevada prevalencia. La estadía hospitalaria prolongada, la presencia de leucocitosis, la hidratación parenteral y colocación de acceso venoso central fueron factores predictivos de descenso de hemoglobina = 2 g/dl.

ABSTRACT

It is common to observe the development of anemia in hospitalized patients, especially in critical cases. Few studies have evaluated its prevalence and associated factors in patients in the general ward. The purpose of this study is to determine the prevalence, characteristics and associated clinical factors of hospital-acquired anemia and the drop of hemoglobin concentration in hospitalized patients. This is a cross-sectional, prospective and descriptive study. A total of 192 consecutive in-patients in the general ward were studied. Associated risk factors to the drop in hemoglobin by = 2g/dl were analyzed; 139 patients (72.4%) presented anemia; 89 of them (46.4%) had it at admission and 50 (26%) developed hospital-acquired anemia, 47 out of 192 showed a drop in hemoglobin = 2 g/dl(24.48%). They also presented lower values of hematocrite and hemoglobin at discharge (p = 0.01), parenteral hydration at a higher volume (p = 0.01), and lengthier hospitalizations (p = 0.0001). In the univariate analysis, the following variables were statistically significant risk factors leukocytosis = 11 000 mm³ (OR; IC95% 2,02; 1.03-4; p = 0.01), hospitalization days = 7 (OR; IC95%3.39; 1.62-7.09; p = 0.0006), parenteral hydration = 1500 ml/day (OR; IC95% 2.47; 1.06-6.4; p = 0.01), central venous access (OR; IC95%10.29; 1.75-108.07; p = 0.003) and hospital-acquired anemia (OR; IC95% 7.06; 3.41-15.83; p = 0.00000004). In the multivariate analysis, the following variables were independent predictive factors of the hemoglobin decrease = 2 g/dl leukocytosis = 11 000 mm³ (OR; IC95% 2.45; 1.14-5,27; p = 0.02), hospitalization days = 7 (OR; IC95%5.15; 2.19-12.07; p = 0.0002), parenteral hydration = 1500 ml/day (OR; IC95% 2.95; 1.13-7.72; p = 0.02), central venous access (OR; IC95%8.82; 1.37-56.82; p = 0.02). Hospital-acquired anemia has a high prevalence. Lengthier stays, presence of leukocytosis, parenteral hydration and central venous access placement are predictive factors of the drop in hemoglobin = 2 g/dl.