Anemia is a hallmark of critical illness, which is largely inflammatory driven. We hypothesized that the use of anti-inflammatory agents limits the development of anemia and reduces the need for red blood cell (RBC) transfusions in patients with a hyper-inflammatory condition due to COVID-19. An observational cohort (n = 772) and a validation cohort (a subset of REMAP-CAP, n = 119) of critically ill patients with hypoxemic respiratory failure due to COVID-19 were analyzed, who either received no treatment, received steroids or received steroids plus IL-6 blocking agents. The trajectory of hemoglobin (Hb) decline and the need for RBC transfusions were compared using descriptive statistics as well as multivariate modeling. In both cohorts, Hb level was higher in the treated groups compared to the untreated group at all time points. In the observational cohort, incidence and number of transfused patients were lower in the group receiving the combination treatment compared to the untreated groups. In a multivariate analysis controlling for baseline Hb imbalance and mechanical ventilation, receipt of steroids remained associated with a slower decline in Hb level and the combination treatment remained associated with a slower decline of Hb and with less transfusions. Results remained the same in the validation cohort. Immunomodulatory treatment was associated with a slower decline in Hb level in critically ill patients with COVID-19 and with less transfusion. Findings point toward inflammation as an important cause for the occurrence of anemia in the critically ill.

中文翻译：

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抗炎治疗与危重患者贫血延迟发作和输血需求减少相关：两项研究的结果

贫血是危重疾病的一个标志，其很大程度上是由炎症引起的。我们假设，抗炎药的使用可以限制贫血的发生，并减少因 COVID-19 导致的高炎症患者对红细胞 (RBC) 输注的需要。对因 COVID-19 导致低氧性呼吸衰竭的危重患者的观察队列 (n = 772) 和验证队列（REMAP-CAP 的子集，n = 119）进行了分析，这些患者要么未接受治疗，要么接受类固醇治疗，要么接受类固醇加 IL-6 阻断剂。使用描述性统计数据和多变量模型比较血红蛋白 (Hb) 下降的轨迹和红细胞输血的需要。在两个队列中，在所有时间点，治疗组的 Hb 水平均高于未治疗组。在观察队列中，接受联合治疗组的输血患者发生率和数量均低于未治疗组。在控制基线 Hb 失衡和机械通气的多变量分析中，接受类固醇仍然与 Hb 水平较慢下降有关，而联合治疗仍然与 Hb 较慢下降和较少输血有关。验证队列中的结果保持不变。免疫调节治疗与 COVID-19 危重患者的 Hb 水平下降较慢以及输血量减少有关。研究结果表明炎症是危重患者发生贫血的重要原因。