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 \u3c 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
