Comparative analysis of outcomes between anemic and non-anemic critically ill elderly patients in a geriatric ICU in Egypt: A focused study

Manar Mamdouh Abd Al Kader; Manar Mostafa Adel Maamoun; Walaa W. Aly; Heba Youssif Youssif; Mennatallah Safwat Elaraby

doi:10.2478/jccm-2025-0028

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Comparative analysis of outcomes between anemic and non-anemic critically ill elderly patients in a geriatric ICU in Egypt: A focused study

The Journal of Critical Care Medicine

Volume 11 (2025): Issue 3 (July 2025)

By: Manar Mamdouh Abd Al Kader, Manar Mostafa Adel Maamoun, Walaa W. Aly, Heba Youssif Youssif and Mennatallah Safwat Elaraby

Open Access

|Jul 2025

Figures & Tables

Description of grades of anemia among studied subjects

Rate of decline of hemoglobin level among studied subjects

Table 1.

Demographics, premorbid comorbidities and Charsoln comorbidity index among studied subjects (n=216)

Quantitative:	Mean±SD	Range
Age(yrs)	75.00±7.84	60–98

Qualitative:	No	%
Males	88	40.7
Females	128	59.3
Smoking status:
-Non-smokers	170	78.7
-Smokers	25	11.6
-Ex-smokers	21	9.7
Premorbid Comorbidities	No	%
Hypertension	122	56.5
Cardiac diseases¹	84	38.9
Diabetes mellitus	82	38
Dementia	73	33.8
Neurological diseases²	59	27.3
Renal diseases³	38	17.6
Pulmonary diseases⁴	31	14.4
Premorbid anemia	31	14.4
Hepatic diseases⁵	26	12
Charsoln comorbidity index:
-less than 7	140	64.8
-More than or equal 7	76	35.2
Previous ICU admission	50	23.1

1 This includes heart failure, ischemic heart diseases, arrhythmias and valvular heart diseases

2 This includes Stroke, Seizures

3 This includes chronic kidney diseases and End Stage Renal Disease on dialysis

4 This includes Chronic obstructive pulmonary disease, Bronchial asthma, Tuberculosis

5 This includes chronic liver diseases.

Table 2.

Description of outcomes among studied patients

Outcomes	All patients (n=216)	%
In hospital mortality (30 day mortality)	94	43.5

	N = 122	%
Discharge to
-Ward	96	44.4
-Palliative Care unit	21	9.7
-Home	5	2.3

Management of anemia among studied subjects

Table 3.

Comparison between anemic and non-anemic groups as regard age, sex, severity of illness and predictors of mortality tools

	Anemic (n=172) (Mean+SD) (+SEM)	Non anemic (n=44) (Mean+SD) (+SEM)	Student’s “t”/Z	P (Sign.)
Age (yrs)	74.99+7.78	75.05+8.15	“t”= 0.04	(0.97) >0.05(NS)

	No (%)	No (%)	X²	P(Sign.)
Sex
Male	74 (84.1%)	14(15.9%)	1.82	(0.17) >0.05(NS)
Female	98 (76.6%)	30(23.4%)
Severity of illness and Predictors of mortality tools
Initial SOFA	20.78±18.01 (±1.37)	12.12+9.49 (+1.43)	Z=3.21	(0.001) <0.001 (HS)
Mean SOFA	52.51±32.01 (±2.44)	33.37±32.54 (±4.91)	Z=3.69	(0.001) <0.001 (HS)
Highest SOFA	25.99±30.36 (±2.31)	12.48±21.27 (±3.21)	Z=3.56	(0.001) <0.001(HS)
APACHE II	18.27±0. 51	14.05±0.92	“t”= 3.79	(0.001) <0.001(HS)
APACHE IV	71.98±19.9	63.8±15.58	“t”= 2.54	(0.012) <0.05 (S)
MPM 24 hrs	31.86±20.42 (±1.56)	22.59±15.19 (±2.29)	Z=3.08	(0.002) <0.05 (S)
MPM 48 hrs	37.79±22.73 (±1.75)	27.58± 18.92 (±2.85)	Z=2.96	(0.003) <0.05 (S)
MPM 72hrs	40.53±23.19 (±1.82)	29.45± 19.08 (±2.98)	Z=3.04	(0.002) <0.05 (S)
SAPSIII	68.11±11.61	62.78±9.16	“t”= 2.82	(0.005) <0.05 (S)

[i] Sequential organ failure (SOFA); Acute Physiology and Chronic Health Evaluation (APACHE); Mortality Probability Model (MPM); Simplified Acute Physiology Score (SAPS)

Table 4.

Comparison between anemic and non-anemic as regard Comorbidity data and Charlson Comorbidity index

Comorbidities	Anemic (n=172) No (%)	Non-anemic (n=44) No(%)	X²	P(Sign)
Neurological diseases¹	49(83.1%)	10(16.9%)	4.23	(0.44)>0.05(NS)
Hypertension	101(61.5%)	21(17.2%)	1.72	(0.18)>0.05(NS)
Pulmonary diseases¹	28(90.3%)	3(9.7%)	2.55	(0.11)>0.05(NS)
COVID 19 infection	10(76.9%)	3(23.1%)	0.06	(0.8)>0.05(NS)
Diabetes Mellitus	67 (81.7%)	15(18.3%)	0.35	(0.55)>0.05(NS)
Cardiac disease³	69 (82.1%)	15 (17.9%)	0.53	(0.46)>0.05(NS)
Renal disease⁴	35 (92.1%)	3 (7.9%)	4.42	(0.03)<0.05(S)
Hepatic diseases⁵	23(88.5%)	3(11.5%)	1.42	(0.23)>0.05(NS)
Premorbid Anemia	30(96.8%)	1(3.2%)	6.55	(0.01)<0.05(S)
Dementia	56 (76.7%)	17 (23.3%)	0.57	(0.44)>0.05(NS)
Malignancy	29(90.6%)	3(9.4%)	2.80	(0.09) >0.05(NS)
Previous ICU admission	47(94%)	3(6%)	8.28	(0.004)<0.05(S)
Charlson Comorbidity Index
<7	105(75%)	35(25%)	5.25	(0.02)<0.05(S)
>7	67(88.2%)	9(11.8%)

1 This includes Stroke, Seizures;

2 This includes Chronic obstructive pulmonary disease, Bronchial asthma, Tuberculosis;

3 this includes heart failure, ischemic heart diseases, arrhythmias and valvular heart diseases;

4 This includes chronic kidney diseases and End Stage Renal Disease on dialysis;

5 This includes chronic liver diseases.

Table 5.

Comparison between anemic and non-anemic groups as regard hemodynamic support, mechanical ventilation and outcomes

	Anemic (n=172) (Mean±SD) (±SEM)	Non anemic (n=44) (Mean±SD) (±SEM)	Student’s “t”/Z	P(sign.)
Outcomes:
Length of stay (LOS)(Days)	8.42±0.46	7.68±0.97	“t”= 0.71	0.04 <0.05(S)

	No(%)	No(%)	X²	P(sign.)
In hospital mortality	83(88.3)	11(11.7)	7.71	(0.05) <0.05(S)
Hospital acquired infections	118(82.5%)	25(17.5%)	2.17	(0.14) >0.05(NS)
Hospital acquired pneumonia(HAP)	78(83.9%)	15(16.1%)	10.21	(0.001) <0.05(S)
Interventions
Vasopressor	36(81.8%)	8(18.2%)	0.16	(0.68) >0.05(NS)
Mechanical ventilation	28(84.8%)	5(15.2%)	0.65	(0.41) >0.05(NS)

** There was no statistically significant difference between both groups regarding Ventilator associated pneumonia (VAP), Central line associated blood stream associated infection, Diarrhea, Urinary tract infection and acquired pressure ulcers (not mentioned in table 5).

Table 6.

Linear regression analysis for factors affecting of mortality in ICU

	Unstandardized B	Coefficients Std. Error	Standardized Coefficients Beta	t	P-value (Sign.)
Age	0.006	0.004	0.088	1.51	0.13(NS)
Smoking	0.113	0.044	0.146	2.53	0.012(S)
Previous ICU admission	−0.006	0.069	−0.005	−0.08	0.93(NS)
Anemia(past history)	−0.144	0.085	−0.10	−1.68	0.09(NS)
Anemia on admission	0.137	0.092	0.111	1.48	0.14(NS)
Grades of anemia	−0.6	0.04	−0.124	−1.45	0.14(NS)
Hospital acquired anemia	0.100	0.117	0.064	0.85	0.39(NS)
Mechanical ventilation	0.33	0.092	0.24	3.62	0.00(HS)
Vasopressor	0.175	0.09	0.14	1.94	0.05(S)
Blood transfusion	0.184	0.07	0.17	2.48	0.01(S)
CRP	0.001	0.00	0.12	2.19	0.02(S)
Platelets	0.00	0.00	0.143	−2.88	0.00(HS)
MPM72 hours	0.01	0.005	0.44	2.07	0.04(S)

[i] Dependent Variable: in hospital mortality #; Mortality Probability Model (MPM); C reactive protein (CRP); ** Other variables were statistically insignificant predicators of in hospital mortality, including: Total leucocytic count, Alkaline transaminase(ALT), Aspartate transaminase(AST), Tools of predicators of mortality including: MPM24hrs, MPM48hrs, SAPSIII, Acute Physiology and APACHEII, APACHEIV, SOFA, Initial SOFA, mean SOFA, Highest SOFA were not shown in table 6.

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DOI: https://doi.org/10.2478/jccm-2025-0028 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 290 - 300

Submitted on: Nov 6, 2024

Accepted on: Jun 25, 2025

Published on: Jul 31, 2025

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

anemia,

critically ill,

elderly,

hospital acquired infections,

in-hospital mortality

Related subjects:

Medicine,

Clinical medicine,

Internal medicine,

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2025 Manar Mamdouh Abd Al Kader, Manar Mostafa Adel Maamoun, Walaa W. Aly, Heba Youssif Youssif, Mennatallah Safwat Elaraby, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 11 (2025): Issue 3 (July 2025)

Comparative analysis of outcomes between anemic and non-anemic critically ill elderly patients in a geriatric ICU in Egypt: A focused study

Figures & Tables

Fig. 1.

Fig. 2.

Table 1.

Table 2.

Fig. 3.

Table 3.

Table 4.

Table 5.

Table 6.

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