Haemoglobin and C-reactive protein levels are efficient at identifying neoplasms as the most common early mortality of chronic diseases in emergency department patients

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Abstract

Introduction

Extensive research has focused on emergency department (ED) and post-admission deaths, seeking to understand their frequency and causative factors. With the rising prevalence of advanced diseases, it is crucial to identify patients in need of end-of-life care and ensure its high quality. In this epidemiological study, we analyse routine ED blood tests to identify early warning signs of deteriorating patients with common non-traumatic and non-infectious (chronic) conditions.

Material and methods

We conducted a retrospective single-centre study for the years 2016–2019 using medical records and electronic data from the Multi-Specialistic Hospital in Gorzów Wielkopolski, Poland. We examined 8971 unique patients with circulatory, neoplastic, and endocrine diseases. We assessed the impact of 2 grouping variables (survivors and non-survivors) on a continuous outcome variable, including age and 37 routine blood tests.

Results

Two-way analysis of variance revealed that haemoglobin (Hb), haematocrit (Hct), and C-reactive protein (CRP) are the best differentiating biomarkers for early death in ED patients with cardiovascular, oncological, and endocrine diseases (excluding Hct due to its strong correlation with Hb). The Marczewski-Steinhaus taxonomy highlighted that oncological patients had the shortest survival time, averaging just 2 days from admission among ED non-survivors.

Conclusions

Among routinely tested ED biomarkers, Hb and CRP levels are efficient at identifying neoplasms as the most common early mortality of chronic diseases in ED patients.

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Most cited references 14

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Prevalence and outcomes of anemia in cancer: a systematic review of the literature.

Lodovico Balducci, Sally Wade, Kevin Knight (2004)

Anemia is common in patients with cancer. This systematic literature review of reports published in 1966 through February 2003 identified the prevalence of anemia in specific cancers and assessed the impact of anemia on survival and quality of life (QOL). Studies about chemotherapy-induced anemia were excluded. Anemia prevalence varied widely; most studies found that between 30% and 90% of patients with cancer had anemia. Prevalence was affected strongly by the definition of anemia: 7% of patients with Hodgkin disease had anemia when the condition was defined as a hemoglobin level <90.0 g/L; as many as 86% of patients had anemia when it was defined as a hemoglobin value <110.0 g/L. Prevalence varied by cancer type and disease stage: 40% of patients with early-stage colon tumors and nearly 80% of patients with advanced disease had anemia. Patients with anemia had poorer survival and local tumor control than did their nonanemic counterparts in 15 of 18 studies. In 8 of 12 studies, patients without anemia (most treated with epoetin) needed fewer transfusions. QOL was positively correlated with hemoglobin levels in 15 of 16 studies. There was no significant difference in treatment toxicity between patients with and without anemia. Tumor hypoxia, which has been associated with resistance to radiation therapy and chemotherapy, may stimulate angiogenesis, leading to poor local control of tumors and increased morbidity and mortality. Treatment of anemia may have a significant impact on patient survival and QOL. However, a standard definition of anemia is needed, as is research about the effect of anemia on cancer progression.

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C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease.

Robert Wise, Don Sin, N R Anthonisen … (2006)

Although C-reactive protein (CRP) levels are increased in chronic obstructive pulmonary disease (COPD), it is not certain whether they are associated with adverse clinical outcomes. Serum CRP levels were measured in 4803 participants in the Lung Health Study with mild to moderate COPD. The risk of all-cause and disease specific causes of mortality was determined as well as cardiovascular event rates, adjusting for important covariates such as age, sex, cigarette smoking, and lung function. Cardiovascular events were defined as death from coronary heart disease or stroke, or non-fatal myocardial infarction or stroke requiring admission to hospital. CRP levels were associated with all-cause, cardiovascular, and cancer specific causes of mortality. Individuals in the highest quintile of CRP had a relative risk (RR) for all-cause mortality of 1.79 (95% confidence interval (CI) 1.25 to 2.56) compared with those in the lowest quintile of CRP. For cardiovascular events and cancer deaths the corresponding RRs were 1.51 (95% CI 1.20 to 1.90) and 1.85 (95% CI 1.10 to 3.13), respectively. CRP levels were also associated with an accelerated decline in forced expiratory volume in 1 second (p or =5 year mortality. CRP measurements provide incremental prognostic information beyond that achieved by traditional markers of prognosis in patients with mild to moderate COPD, and may enable more accurate detection of patients at a high risk of mortality.

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The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients.

Patrizia Olmi, Dirk Schrijvers, Heinz Ludwig … (2004)

The European Cancer Anaemia Survey (ECAS) was conducted to prospectively evaluate the prevalence, incidence and treatment of anaemia (haemoglobin <12.0 g/dL) in European cancer patients, including the relationship of mild, moderate and severe anaemia to performance status. Patients were evaluated for up to 6 months. Data (N=15367) included demographics, tumour type, performance status, haemoglobin levels, cancer treatments and anaemia treatments. Prevalence of anaemia at enrollment was 39.3% (haemoglobin <10.0 g/dL, 10%), and 67.0% during the survey (haemoglobin <10.0 g/dL, 39.3%). Low haemoglobin levels correlated significantly with poor performance status. Incidence of anaemia was 53.7% (haemoglobin <10.0 g/dL, 15.2%). Anaemia was treated in 38.9% of patients (epoetin, 17.4%; transfusion, 14.9%; and iron, 6.5%). Mean haemoglobin to initiate anaemia treatment was 9.7 g/dL. Anaemia prevalence and incidence in cancer patients are high. Anaemia significantly correlates with poor performance status and many anaemic patients are not treated.

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Author and article information

Journal

Journal ID (nlm-ta): Contemp Oncol (Pozn)

Journal ID (iso-abbrev): Contemp Oncol (Pozn)

Journal ID (publisher-id): WO

Title: Contemporary Oncology

Publisher: Termedia Publishing House

ISSN (Print): 1428-2526

ISSN (Electronic): 1897-4309

Publication date (Electronic): 30 November 2023

Publication date (Print): 2023

Volume: 27

Issue: 3

Pages: 176-181

Affiliations

[1 ]District Hospital in Racibórz, Racibórz, Poland

[2 ]Department of Cardiology, University Hospital in Opole, Opole, Poland

[3 ]Institute of Medical Science, Opole University, Opole, Poland

[4 ]Multispecialty Hospital in Zgorzelec, Zgorzelec, Poland

Author notes

Address for correspondence Andrzej Tukiendorf Institute of Medical Science, Opole University, 68 Katowicka St. 45-060 Opole, Poland e-mail: andrzej.tukiendorf@ 123456gmail.com

Article

Publisher ID: 51941

DOI: 10.5114/wo.2023.133352

PMC ID: 10793625

PubMed ID: 38239859

SO-VID: 7a9d92c0-9e55-43a9-bae8-6985f35b6452

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)

Haemoglobin and C-reactive protein levels are efficient at identifying neoplasms as the most common early mortality of chronic diseases in emergency department patients

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Abstract

Introduction

Material and methods

Results

Conclusions

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Annual Reviews HIV/AIDS: Public Health and Society

Most cited references 14

Prevalence and outcomes of anemia in cancer: a systematic review of the literature.

C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease.

The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients.

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