Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection
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ORIGINAL ARTICLE
Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection Abdulrahman A. Algassim 1,2 & Assem A. Elghazaly 3 & Abdulrahman S. Alnahdi 1 & Owais M. Mohammed-Rahim 1 & Abdulaziz G. Alanazi 1,2 & Nawaf A. Aldhuwayhi 1,4 & Mashael M. Alanazi 5 & Mohammed F. Almutairi 5 & Ibrahim M. Aldeailej 5 & Najeeb A. Kamli 5 & Mahmoud D. Aljurf 6 Received: 25 August 2020 / Accepted: 1 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Higher levels of D-dimer, LDH, and ferritin, all have been associated with the poor prognosis of COVID-19. In a disease where there are acute inflammation and compromised oxygenation, we investigated the impact of initial hemoglobin (Hgb) levels at Emergency Department (ED) triage on the severity and the clinical course of COVID-19. We conducted a cross-sectional study on 601 COVID-19 patients in a COVID-19 national referral center between 13 and 27 June 2020. All adult patients presented at our hospital that required admission or hotel isolation were included in this study. Patients admitted to the intensive care unit (ICU) had a lower initial Hgb than those admitted outside the ICU (12.84 g/dL vs. 13.31 g/dL, p = 0.026) and over the course of admission; the prevalence of anemia (Hgb < 12.5 g/dL) was 65% in patients admitted to ICU, whereas it was only 43% in non-ICU patients (odds ratio of 2.464, 95% CI 1.71–3.52). Anemic ICU patients had a higher mortality compared with non-anemic ICU patients (hazard ratio = 1.88, log-rank p = 0.0104). A direct agglutination test (DAT) for all anemic patients showed that 14.7% of ICU patients and 9% of nonICU patients had autoimmune hemolytic anemia (AIHA). AIHA patients had significantly longer length of hospital stay compared with anemic patients without AIHA (17.1 days vs. 14.08 days, p = 0.034). Lower Hgb level at hospital presentation could be a potential surrogate for COVID-19 severity. Keywords Anemia . Hemolysis . AIHA . COVID-19 . Prognosis
Abdulrahman S. Alnahdi, Owais M. Mohammed-Rahim and Abdulaziz G. Alanazi contributed equally to this work. * Abdulrahman A. Algassim [email protected] 1
Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
2
Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
3
Department of Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
4
Department of Medicine, Prince Mohammed Medical City, Sakaka, Al-Jouf, Saudi Arabia
5
Regional Laboratory and Blood Bank, Ministry of Health, Riyadh, Saudi Arabia
6
Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
Introduction Coronavirus disease 2019 (COVID-19) is a recently emerged disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. COVID-19 has a wide spectrum of manifestations, from asymptomatic infection to complicated pneumonia with acute respiratory distress syndrome (ARDS) [2] together with other extra-pulmonary manifestations [3].
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