Original article In-hospital Acquired Anemia in Acute Coronary Syndrome. Predictors, In-hospital Prognosis and One-year Mortality Oona Meron ˜o, a,b, * Merce ´ Cladellas, a Lluis Recasens, a Cosme Garcia-Garcia, a Nu ´ ria Ribas, a Victor Bazan, a Nu ´ ria Farre ´, a A ´ lvaro Sainz, a Josep Comin, a and Jordi Bruguera a a Servicio de Cardiologı´a, Hospital Universitario del Mar, Barcelona, Spain b Doctorando en Medicina Interna, Universidad Auto ´noma de Barcelona, Barcelona, Spain Rev Esp Cardiol. 2012;65(8):742–748 Article history: Received 30 September 2011 Accepted 6 March 2012 Available online 17 June 2012 Keywords: Hospital-acquired anemia Nosocomial anemia Acute coronary syndrome Prognosis Inflammatory state A B S T R A C T Introduction and objectives: Anemia at hospital admission predicts a poor outcome in patients presenting with acute coronary syndrome. It remains unclear whether in-hospital hemoglobin levels decrease (nosocomial anemia) not related to bleeding also implies a poor prognosis. We aimed to identify predictors of nosocomial anemia and its prognostic significance. Methods: We prospectively included 221 acute coronary syndrome patients admitted in our institution during the years 2009-2010, with normal hemoglobin levels at admission. Nosocomial anemia was defined as a decrease in hemoglobin levels to <13g/dL in men and <12g/dL in women in the absence of apparent bleeding. Clinical variables and hematological inflammatory parameters were assessed in order to identify predictors for the development of nosocomial anemia. We compared the clinical outcome after a 1-year follow-up period of patients without anemia as opposed to those who developed nosocomial anemia. Results: Nosocomial anemia was registered in 25% of study patients. A >3.1 mg/dL value of C-reactive protein was highly predictive of developing nosocomial anemia (odds ratio=5.9; 95% confidence interval, 2.6-13.4; P<.001). The incidence of mortality and cardio-vascular morbidity was higher in the patients who developed nosocomial anemia (34.5% vs 9%; P<.001). Nosocomial anemia was a strong predictor of cardio-vascular morbidity and mortality in the long-term follow-up (hazard ratio=2.47; 95% confidence interval, 1.23-4.96; P=.01). Conclusions: Nosocomial anemia predicts a poorer outcome in patients with acute coronary syndrome. Increased C-reactive protein levels, indicating inflammatory state, are predictive of developing in-hospital anemia unrelated to apparent bleeding. ß 2012 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. Anemia adquirida en el sı ´ndrome coronario agudo. Predictores, prono ´ stico intrahospitalario y mortalidad a un an ˜o Palabras clave: Anemia adquirida intrahospitalaria Anemia nosocomial Sı ´ndrome coronario agudo Prono ´ stico Estado inflamatorio R E S U M E N Introduccio ´n y objetivos: La anemia al ingreso por un sı ´ndrome coronario agudo es un factor de mal prono ´ stico. Sin embargo, hay poca informacio ´n sobre la anemia que se adquiere durante el ingreso por un sı ´ndrome coronario. Nuestro objetivo es determinar posibles predictores de anemia nosocomial y evaluar su influencia prono ´ stica en el sı ´ndrome coronario agudo. Me ´todos: Se incluyo ´ prospectivamente a 221 pacientes que ingresaron en nuestro centro por un sı ´ndrome coronario (2009-2010) con valores de hemoglobina normales. Se definio ´ anemia nosocomial sin sangrado evidente como reduccio ´n de hemoglobina a valores < 13 g/dl en varones y < 12 g/dl en mujeres. Se analizo ´ el prono ´ stico a 1 an ˜o de seguimiento comparando a los pacientes con anemia nosocomial con los que se mantuvieron sin anemia. Se excluyo ´ del ana ´ lisis a los pacientes con complicaciones hemorra ´ gicas. Resultados: Se observo ´ anemia nosocomial en el 25% de los pacientes. El ana ´ lisis multivariable revelo ´ una asociacio ´n entre proteı ´na C reactiva > 3,1 mg/dl y aparicio ´n de anemia nosocomial (odds ratio = 5,9; intervalo de confianza del 95%, 2,6-13,4; p < 0,001). Al an ˜o de seguimiento, el 34,5% de los pacientes con anemia nosocomial habı ´an sufrido complicaciones cardiovasculares y/o muerte, frente al 9% de los que se mantuvieron sin anemia (p < 0,001). La anemia nosocomial resulta ser un predictor potente de mortalidad total y de complicaciones cardiovasculares (hazard ratio = 2,47; intervalo de confianza del 95%, 1,23-4,96; p = 0,01). * Corresponding author: Servicio de Cardiologı ´a, Hospital del Mar, Pg. Marı ´tim 25, 08003 Barcelona, Spain. E-mail address: 98605@imas.imim.es (O. Meron ˜ o). 1885-5857/$ – see front matter ß 2012 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. http://dx.doi.org/10.1016/j.rec.2012.03.008 Document downloaded from https://www.revespcardiol.org/, day 26/11/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/, day 26/11/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.