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Anemia at Discharge From the PICU: A Bicenter Descriptive Study

Demaret, Pierre MD, MSc1,2; Valla, Frédéric V. MD, MSc3; Behal, Hélène BST4; Mimouni, Yanis PharmD5; Baudelet, Jean-Benoît MD6; Karam, Oliver MD, PhD7; Recher, Morgan MD2,6; Duhamel, Alain MD, PhD2,4; Tucci, Marisa MD, FRCPC8; Javouhey, Etienne MD, PhD3; Leteurtre, Stéphane MD, PhD2,6

Pediatric Critical Care Medicine: September 2019 - Volume 20 - Issue 9 - p e400-e409
doi: 10.1097/PCC.0000000000002015
Online Clinical Investigations

Objective: To determine the prevalence and risk markers of anemia at PICU discharge.

Design: Bicenter retrospective cohort study.

Setting: Two multidisciplinary French PICUs.

Patients: All children admitted during a 5-year period, staying in the PICU for at least 2 days, and for whom a hemoglobin was available at PICU discharge.

Interventions: None.

Measurements and Main Results: Patient, admission, and PICU stay characteristics were retrospectively collected in the electronic medical records of each participating PICU. Anemia was defined according to the World Health Organization criteria. Among the 3,170 patients included for analysis, 1,868 (58.9%) were anemic at discharge from PICU. The proportion of anemic children differed between age categories, whereas the median hemoglobin level did not exhibit significant variations according to age. After multivariate adjustment, anemia at PICU admission was the strongest predictor of anemia at PICU discharge, and the strength of this association varied according to age (interaction). Children anemic at PICU admission had a reduced risk of anemia at PICU discharge if transfused with RBCs during the PICU stay, if less than 6 months old, or if creatinine level at PICU admission was low. Children not anemic at PICU admission had an increased risk of anemia at PICU discharge if they were thrombocytopenic at PICU admission, if they had higher C-reactive protein levels, and if they received plasma transfusion, inotropic/vasopressor support, or mechanical ventilation during the PICU stay.

Conclusions: Anemia is frequent after pediatric critical illness. Anemia status at PICU admission defines different subgroups of critically ill children with specific prevalence and risk markers of anemia at PICU discharge. Further studies are required to confirm our results, to better define anemia during pediatric critical illness, and to highlight the causes of post-PICU stay anemia, its course, and its association with post-PICU outcomes.

1Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium.

2Université de Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France.

3Pediatric Intensive Care Unit, Hôpital Universitaire Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.

4CHU Lille, Unité de Biostatistiques, F-59000 Lille, France.

5EPICIME (Epidémiologie, Pharmacologie, Investigation Clinique, Information Médicale, Mère-Enfant), Clinical Investigation Center, Hospices Civils de Lyon, Lyon, France.

6CHU Lille, Pediatric Intensive Care Unit, F-59000 Lille, France.

7Division of Pediatric Critical Care Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA.

8Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada.

This work was performed at the Hôpital Universitaire Jeanne de Flandre, Service de Réanimation Pédiatrique 2, Avenue Eugène Avinée, 59037 Lille Cedex, France, and Hôpital Universitaire Femme Mère Enfant, Hospices Civils de Lyon, Service de Réanimation Pédiatrique, 59, Boulevard Pinel, 69677 Lyon-Bron, France.

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The authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies