Background: The dilemma of who is at highest risk for COVID-19 severe disease and death persists. Hemoglobin levels may be an indicator of COVID-19 disease severity. There is inconsistent data on Emergency Department (ED) hemoglobin levels and severity of disease. Our objective was to examine if COVID-19 patients presenting with abnormal hemoglobin levels have an increased risk of severe disease and in-hospital mortality.
Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA to investigate the relationship of COVID-19 disease severity with hemoglobin level. Inclusion criteria consisted of ED patients over 18 years with a COVID-19 diagnosis from July 1, 2021, to November 1, 2021. Exclusion criteria consisted of duplicate visits and patients without a hemoglobin value recorded. Patients with anemia were stratified by severity. Disposition categories from most to least severe were: ICU/PCU, medical floor, or discharge from ED. In-hospital mortality was recorded. Backward linear regression followed by z-tests were used for each abnormal hemoglobin category versus normal hemoglobin category.
Results: The four-month period included 341 ED visits coded for COVID-19. After excluding 113 visits, 228 were eligible for analysis. There were 132 discharged from the ED, 64 admitted to the medical floor, 32 to ICU/PCU, and 19 deaths. Backwards linear regression showed hemoglobin category was a significant predictor of hospital disposition (p < 0.0001) and mortality (p = 0.07). Z-test showed a significant difference in disposition for normal hemoglobin versus mild anemia (z = 2.1927, p = 0.03) and normal hemoglobin versus moderate/severe anemia (z = 3.6225, p = 0 0003). Z-test showed a significant difference in death for normal hemoglobin versus moderate/severe anemia (z = 3.2949, p = 0.001). Normal hemoglobin versus elevated hemoglobin had no significant difference for disposition (z = 0.356, p = 0.72) or death (z = 1.786, p = 0.07).
Discussion: Abnormal hemoglobin is associated with severity of disease and death COVID-19 patients. Increasingly severe anemia is more associated with severity of disease and death. Elevated hemoglobin is not associated with severity of disease or death.
Sarcia N, Thai D, Bodine AM. Hemoglobin As A Predictor For COVID-19 Disease Severity. Advances in Clinical Medical Research and Healthcare Delivery. 2022; 2(2). doi: 10.53785/2769-2779.1096.