Profound Anemia in Hospitalized Community Acquired Pneumonia Patients is Associated with Increased Mortality and is Prevalent in All Patients’ Age-groups. A Retrospective Analysis of 15,121 Patients

Profound Anemia in Hospitalized Community Acquired Pneumonia Patients is Associated with Increased Mortality and is Prevalent in All Patients’ Age-groups. 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A Retrospective Analysis of 15,121 Patients Yehonatan Marziano, Daniella Itzhak, Yoav Halperin, Victoria Gershman, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5701716/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 7 You are reading this latest preprint version Abstract Background. Community acquired Pneumonia (CAP) is a widespread and potentially lethal disease. Acute anemia is a common phenomenon featuring many such instances. However, the prevalence and clinical implications of anemia in younger CAP patients is unknown. This study aimed to assess the prevalence and clinical outcomes of anemia in patients with CAP treated in a modern-time treated CAP (with current treatment strategies?). Methods. This was a retrospective analysis of CAP patients that were hospitalized during 2010–2024 in a large, tertiary medical center. Results. Following approval by the Institutional Review Board, we retrieved data relating to 17,336 adult patients hospitalized with CAP, of whom relevant clinical data were available for 15,121 patients. The median age was 77 years (IQR 22.2) and 55.2% of the cohort were males. Female patients were more common in the lower hemoglobin patients’ groups (43.9% amongst Hg ≥ 10g/dL, 49.6% in the 8g/dL ≤ Hb < 10g/dL group and 51.7% in the Hb < 8g/dL group of patients; p < 0.05). Interestingly, the median age of patients with severe anemia (73.6 years [IQR 19.6]) was lower than that of the other groups: 78.6 [IQR 18.4] in the 8g/dL ≤ Hb < 10g/dL group and 76.7 [IQR 22.9] in the Hg ≥ 10g/dL group (p < 0.001). Profound anemia and advanced age were identified as independent risk factors for both short- and long-term mortality. Conclusions. Profound anemia affects hospitalized CAP patients across all age groups and remains an independent risk factor for adverse clinical outcomes in the second decade of the 21st century. Anemia Community Acquired Pneumonia Mortality Age Prognosis Figures Figure 1 Figure 2 Background Anemia as a prevalent phenomenon in patients with pneumonia . Community-acquired pneumonia (CAP) is a common cause of hospitalization, affecting both healthy individuals and those with comorbidities. While the prevalence of anemia in critically ill patients is well-documented, its occurrence in hospitalized CAP patients without significant comorbidities or severe illness is less understood ( 1 ). Schoorl M. et al., analyzed healthy subjects without known comorbidities who were hospitalized for CAP. They were investigated for changes in hematological laboratory values and parameters, particularly focusing on the development of anemia. The results demonstrated a decline in hemoglobin (Hb) levels, accompanied by low reticulocyte counts and a temporary impairment in hematopoiesis during the early stages of hospitalization, with a recovery of Hb and Reticulocytes to normal range values between days 4 and 14 of hospitalization during antibiotic treatment ( 2 ). Previous studies have demonstrated that even among patients without known comorbidities, CAP can lead to the development of anemia, with declines in hemoglobin concentration and reticulocyte counts upon hospital admission ( 1 , 3 ). These fluctuations suggest a transient impairment in iron utilization for hemoglobin synthesis during inflammation, potentially due to functional iron depletion ( 1 , 3 ). Furthermore, some patients may present with anemia concurrent with pneumonia rather than pre-existing comorbidities ( 1 , 3 ). Rease et al., showed that even among previously healthy subjects, the development of anemia during hospitalization was common (~ 55% of subjects). When anemia was moderate to severe (≤ 10 g/dL), its development was independently associated with increased 90 days mortality ( 1 ). Aside from the Hb concentration, higher red cell distribution width (RDW) values were found to be significantly correlated with increased severity of CAP, as reflected by higher Pneumonia Severity Index (PSI) and CURB-65 scores. Moreover, patients with higher RDW values experienced higher short-term mortality rates. Importantly, RDW values were not associated with anemia prior to admission, combining RDW with PSI and CURB-65 was found to improve the predictive performance for CAP 90-day mortality risk ( 4 , 5 ). Another retrospective study by Braun et al., found that elevated RDW levels on admission of young patients (60 years old or younger) without known comorbidities suffering from CAP, were significantly associated with higher rates of mortality and complicated hospitalization ( 6 ). Mechanisms underlying the anemia development during pneumonia . The mechanism underlying anemia in CAP involves, along other patho-physiologies, the dysregulation of hepcidin, an iron-regulatory hormone, which suppresses erythropoiesis and depletes iron stores during inflammation ( 7 ). Parrow et al., at explored the sequestration and scavenging of iron during infection and elaborated on iron-related bacterial genes required to establish or maintain infection ( 8 ). The development of anemia was found intricately tied to the body's response to infection. While not fully understood, extracellular pathogens like streptococcus pneumoniae , may access ferritin released from damaged or lysed cells by virulence factors ( 9 ). Aim of the current study This retrospective analysis aims to comprehensively evaluate the prevalence and clinical implications of anemia in adults with CAP.. The primary objective was to determine whether, despite advancements in CAP treatment, anemia remains a significant negative prognostic factor for CAP patients in the second decade of the 21st century.. Patients and Methods Patients cohort Patient data were retrieved from their electronic medical records. The inclusion criteria were a). age over 18 years, b). hospitalized patients admitted from the emergency department to hospital wards with a working diagnosis of pneumonia (based on various ICD-10 codes). The following data were collected: demographics (age, gender), chronic diagnoses and prespecified medications, and laboratory parameters during hospitalization. The following clinical outcomes were also documented: length of hospital stay (LOS) in days and mortality at 30, 60 and 90-days post hospitalization. Mortality events after hospital discharge were determined using the Israeli national population registry. Methods Descriptive statistics: categorical values were described using numbers and percentages. Continuous variables were divided according to their distribution: normally distributed variables were described as means ± standard deviations (SD) while non-normally distributed variables were described as median and inter-quartile range (IQR). Analytic statistics: normality of variables was determined using Shapiro-Wilk test. Categorical variables were compared using the chi-square test. Continuous variables were compared using t-test, ANOVA or Kruskal-Wallis tests according to their distribution patterns. All tests regarded p-value lower than 5% as statistically significant. Tests were executed using Python Ver. 3.9.6. Results Following approval from the Chaim Sheba Medical Center Institutional Review Board (IRB, approval # SMC-D-1250-24) in accordance with the declaration of Helsinki, and a waiver of informed consent due to the retrospective nature of this study, patients’ Electronic Medical Records (EMRs) were accessed, and clinical data were retrieved. The study included patients older than 18 years of age, that were admitted to the Chaim Sheba Medical Center, Israel’s largest tertiary medical center, between 2010 and 2024. We assumed that during this period no significant changes took place regarding the management of anemia in hospitalized, CAP patients. We retrieved data for 17,336 adult patients who were hospitalized due to Community-Acquired Pneumonia (CAP). After excluding 2,215 patients due to insufficient data (as shown in the CONSORT flow diagram, Fig. 1 ), the final study cohort included 15,121 patients. The median age of the entire cohort was 77 years (IQR 22.22), with 55.2% of the patients being males. The characteristics of the study cohort are presented in Table 1 , categorized by anemia severity (Hb > 10 g/dL, between 8 and 10 g/dL, and profound anemia defined as Hb < 8 g/dL). Almost all patients were empirically treated by antibiotics due to the inherent difficulties in distinguishing between bacterial and viral CAP, especially upon patients’ admission: antibiotics were given according to accepted guidelines (mostly by third generation cephalosporine and respiratory quinolone or macrolide). Female patients were more prevalent in the lower hemoglobin groups (43.9% amongst Hg ≥ 10g/dL, 49.6% in the 8g/dL ≤ Hb < 10g/dL and 51.7% in the Hb < 8g/dL group ; p < 0.05). Relating to patients’ age, the median age was higher in the 8g/dL ≤ Hb < 10g/dL group compared to the Hg ≥ 10g/dL group (78.6 years [IQR 18.4] vs. 76.7 years [IQR 22.9]), but surprisingly, the median age of patients with severe anemia was lower: 73.6 years [IQR 19.6], (p < 0.001). Background malignancy (both solid tumors and hematologic malignancies) were more common in the lower hemoglobin groups. Table 1. Patients’ characteristics according to Hemoglobin concentrations. Patient characteristics Total cohort N = 15,121 Hb < 8 gr/dL N = 263 8 gr/dL ≤ Hb < 10 gr/dL; N = 1,960 10 gr/dL ≤ Hb N = 12,898 P-value Patients’ demographics Male [N (%)] 8,347 (55.20) 127 (48.29) 987 (50.36) 7,233 (56.08) < 0.05 Age (Years; Median (IQR)) 77.01 (22.22) 73.62 (19.62) 78.64 (18.41) 76.75 (22.94) < 0.001 Background Diagnoses Dementia [N (%)] 1,470 (9.72%) 22 (8.37) 213 (10.87) 1,235 (9.58) 0.14 Diabetes Mellitus [N (%)] 3,476 (23) 76 (28.9) 641 (32.7) 2,759 (21.4) < 0.05 Ischemic Heart Disease [N (%)] 3,188 (22) 58 (22) 510 (26) 2,620 (20.3) < 0.05 Malignancy [N (%)] 3,181 (21) 99 (37.6) 682 (34.8) 2,400 (18.6) < 0.05 Congestive Heart [N (%)] Failure 2,166 (14.32) 36 (13.7) 382 (19.5) 1,748 (13.5) < 0.05 COPD [N (%)] 1953 (12.9) 24 (9.1) 250 (12.8) 1679 (13) 0.17 Chronic medications Steroids [N (%)] 606 (4) 22 (8.4) 111 (5.7) 473 (3.7) < 0.05 Proton pump inhibitor [N (%)] 2143 (14.2) 60 (22.8) 452 (23) 1631 (12.6) < 0.01 Chemotherapy [N (%)] 626 (4.1) 25 (9.5) 208 (10.6) 393 (3) < 0.05 Laboratory parameters Maximal CRP (mg/l; Median (IQR)) 148.59 (150.79) 166.35 (155.22) 156.68 (140.64) 146.57 (152.69) < 0.05 Mean Corpuscular Volume [fL (Median (IQR)] 87.7 (7.8) 86.6 (10.0) 86.5 (10.0) 87.8 (7.5) < 0.05 White blood cells [/mcl (Median (IQR)] 7,750 (4,700) 6,470 (5,670) 7,190 (5,100) 7,870 (4,590) < 0.05 Positive Blood Cultures [N (%)] 747 (4.9) 14 (5.3) 122 (6.2) 611 (4.7) < 0.05 Ferritin [ng/ml (Median (IQR)] 205.6 (365.6) 380.2 (1051.2) 228.9 (493.9) 196.1 (330.2) < 0.05 Iron [mcg/dL (Median (IQR)] 25 (23) 29 (32.5) 24 (23) 29 (32.5) 0.2 Minimal Albumin (g/dl; Median (IQR)) 3.10 (0.70) 2.60 (0.70) 2.80 (0.70) 3.10 (0.80) < 0.05 Maximal Creatinine (mg/dl; Median (IQR)) 1.08 (0.68) 1.30 (1.31) 1.31 (1.21) 1.05 (0.62) < 0.05 Maximal LDH (IU/l; Median (IQR)) 304.00 (187.00) 374.00 (291.00) 318.50 (198.75) 300.00 (183.25) < 0.05 Platelets [K/mcl; (Median (IQR)] 190 (113) 155 (201) 195 (150.2) 189 (108) < 0.05 Alanine amino transferase [IU/L; (Median (IQR)] 24 (28) 25 (29) 23 (27) 24 (28) < 0.05 Treated with antibiotics [N (%)] 14,594 (96.5) 255 (97) 1,915 (97.7) 12,424 (96.3) < 0.05 Clinical outcomes Length of hospital Stay (LOS; days); Median (IQR) 2.61 (4.0) 3.79 (6.28) 3.53 (5.55) 2.50 (3.67) < 0.05 Necessitated Mechanical Ventilation [N (%)] 370 (2.4) 22 (8.4) 75 (3.8) 273 (2.1) < 0.05 Mortality at 30-days [N (%)] 2,070 (13.7) 60 (23) 424 (22) 1,586 (12) < 0.001 Mortality at 60-days [N (%)] 599 (4) 30 (11.4) 120 (6.1) 449 (3.5) < 0.001 Mortality at 90-days [N (%)] 393 (2.6) 13 (5) 88 (4.5) 292 (2.3) < 0.001 Figure 2 describe the survival analysis for three hemoglobin concentrations in both age groups (above and below 65 years). It is evident that in both age groups, lower hemoglobin levels are associated with higher mortality rates. Furthermore, it is also evident that the mortality burden was lower amongst the younger age group. The role of younger age remained surprising in further analyses. As presented in Table 2 , detailing patient characteristics according to age groups, while older age was more prevalent in the two higher Hb groups, amongst patients who suffered from severe anemia (Hb < 8g/dL) both age groups accounted for the same percentages (1.74%,p = NS). Even though younger age did not reduce the prevalence of severe anemia, it did serve as a protective patient characteristic relating to 30-, 60- and 90-days mortality. Table 2 Patients’ characteristics according to age group. Patients Characteristics Age 10 g/dL 445 (10.88%) 1778 (16.12%) < 0.05 8 g/dL < Hb < 10 g/dL 374 (9.14%) 1586 (14.38%) < 0.01 8 g/dL < Hb 71 (1.74%) 192 (1.74%) 1 Necessitated Mechanical Ventilation 87 (2.1%) 283 (2.6%) 0.13 Length of hospital Stay (days; median (IQR)) 1.99 (3.1) 2.78 (4.3) 0.46 Mortality at 30 days 204 (5.0%) 1,866 (16.9%) < 0.05 Mortality at 60 days 68 (1.66%) 531 (4.8%) < 0.05 Mortality at 90 days 46 (1.12%) 347 (3.1%) < 0.05 In a univariate analysis presented in Table 3 , of the following patient characteristics were found to be statistically associated with an increased risk of 30-days mortality: age over 65 years (HR = 3.88 (3.34–4.5); p < 0.01, dementia (HR = 3.45 (95% CI 3.05–3.89); p < 0.01), hemoglobin between 8 to 10 gr/dL (HR = 1.93 (95% CI 1.71–2.18); p < 0.01), hemoglobin lower than 8 gr/dL (HR = 1.89 (95% CI 1.41–2.53); p < 0.01), past chemotherapy treatment (HR = 1.82 (95% CI 1.5–2.21); p < 0.01), renal failure (HR = 1.67 (95% CI 1.5–1.86); p < 0.01), malignancy (HR = 1.66 (95% CI 1.49–1.84); P < 0.01), arterial hypertension (HR = 1.64 (95% CI 1.49–1.8); p < 0.01) and diabetes mellitus (HR = 1.23 (95% CI 1.11–1.37); p < 0.01). In contrast, chronic obstructive pulmonary disease (COPD) and hemoglobin levels higher than 10 gr/dL were found to be relatively protective (HR = 0.84 (95% CI 0.73–0.97); p < 0.05) and HR = 0.5 (95% CI 0.45–0.56); p < 0.01), respectively. Table 3 Univariate analysis for 30 - days mortality. Patients’ characteristic HR (95% CI) P - Value Age ≥ 65 years 3.88 (3.34–4.5) < 0.01 Dementia 3.45 (3.05–3.89) < 0.01 8 gr/dL ≤ hemoglobin < 10 gr/dL 1.93 (1.71–2.18) < 0.01 Hemoglobin < 8 gr/dL 1.89 (1.41–2.53) < 0.01 Positive blood cultures 1.73 (1.44–2.08) < 0.01 Treated with antibiotics 1.47 (1.1–1.96) < 0.01 Chemotherapy treatment 1.82 (1.5–2.21) < 0.01 Renal failure 1.67 (1.5–1.86) < 0.01 Malignancy 1.66 (1.49–1.84) < 0.01 Hypertension 1.64 (1.49–1.8) < 0.01 Diabetes 1.23 (1.11–1.37) < 0.01 COPD 0.84 (0.73–0.97) < 0.05 Hemoglobin ≥ 10 gr/dL 0.5 (0.45–0.56) < 0.01 Table 4 presents a multivariate analysis of patient characteristics that remained of statistical significance in relation to the risk of 30-days mortality. This analysis found that both severe anemia and advanced age were independently associated with increased risk of 30-days mortality (HR = 1.8 (95% CI 1.33–2.44); p < 0.01 and HR = 3.23 (95% CI 2.76–3.78); p < 0.01), respectively. Table 4 Multivariate analysis for 30 - days mortality. Patients’ characteristic HR (95% CI) P - Value Age ≥ 65 years 3.2 (2.73–3.74) < 0.01 Dementia 2.8 (2.46–3.18) < 0.01 Hemoglobin < 8 g/dL 1.79 (1.32–2.43) < 0.01 Positive blood cultures 1.47 (1.22–1.78) < 0.01 Treated with antibiotics 1.1 (0.82–1.48) 0.53 chemotherapy 1.77 (1.42–2.21) < 0.01 Malignancy 1.49 (1.32–1.67) < 0.01 Renal failure 1.23 (1.1–1.38) < 0.01 Hypertension 1.01 (0.91–1.12) 0.9 Discussion The prevalence of anemia in hospitalized patients with CAP varies depending on the definition used. According to the World Health Organization (WHO), anemia is defined as hemoglobin levels of less than 13 g/dL in men, and less than 12 g/dL in women ( 10 ). In our study, we applied a cutoff of 10 g/dL for both genders to assess anemia prevalence in hospitalized CAP patients. We categorized patients into three groups based on hemoglobin concentrations: those with hemoglobin levels above 10 g/dL, those between 8 and 10 g/dL, and those with severe anemia, defined as having hemoglobin levels below 8 g/dL. Previous large inpatient CAP studies, such as the one by Bordon et al., defined anemia as hemoglobin of < 10 g/dL or hematocrit < 30%, yielding a prevalence of anemia at presentation ranging from 7 to12% ( 11 ). Tao et al. found in their retrospective study, that anemia is common among patients suffering from pneumonia, with prevalence rates of 7%-12% in community-acquired pneumonia and 31.8% in severe influenza A ( 12 ). Our study revealed a substantial prevalence of anemia among hospitalized patients with CAP, with a median age of 77 years, consistent with previous literature, showing that older adults are more susceptible to anemia due to various factors, including chronic diseases and nutritional deficiencies ( 13 ). Additionally, our results showed a higher prevalence of anemia in female patients, which aligns with existing literature ( 14 ). Anemia has been widely recognized as a significant risk factor for poor outcomes hospitalized elderly patients ( 13 – 15 ). Roubinian et al. demonstrated that anemia is consistently associated with prolonged hospital stays and is independently linked to both short- and long-term morbidity and mortality ( 15 ). Our study found that severe anemia (Hb < 8 g/dL) is a significant independent predictor of mortality in hospitalized CAP patients, especially in older individuals. The 30-day mortality rate was significantly higher in the severe anemia group (23%) compared to those with moderate anemia (22%), or those without anemia (12%). The Kaplan-Meier survival analysis (Fig. 2 ) revealed a clear trend: lower Hb levels were consistently associated with higher mortality rates across all age groups. However, patients over 65 years had a higher 30-day mortality rate (16.9%) compared those under 65 years (5%). These findings are consistent with prior research, such as Reade et al., which found a clear link between moderate to severe anemia and increased mortality in CAP patients, particularly in older populations ( 1 , 14 – 16 ). Despite previous findings, our study is unique in showing that the prevalence of severe anemia in CAP patients was equally frequent in those below and above 65 years of age, with severe anemia serving as an independent risk factor for poor clinical outcomes. Our unexpected finding was that patients with severe anemia (Hb < 8 g/dL) had a lower median age (73.6 years) compared to those with moderate anemia (8 g/dL < Hb < 10 gr/dL), whose median age was 78.6 years, and those with mild anemia (10 g/dL < Hb), whose median age was 76.75 years. Both younger and older age groups had the same prevalence of severe anemia, with 1.7% of patients in each group exhibiting hemoglobin levels below 8 g/dL. These findings should be even more surprising in light of the fact that older patients had, most probably, higher prevalence of chronic co-morbidities. Conclusions The authors of this manuscript would like to emphasize the significance of our findings. Our results challenge the assumption that younger, healthier individuals are less vulnerable to anemia in the context of CAP, challenging the common perception that severe anemia primarily affects older patients. Profound anemia affects hospitalized CAP patients below and above the age of 65 years and should be considered as an independent risk factor for patients’ mortality regardless of patient age. Furthermore, we assert that anemia remains a major risk factor for mortality in hospitalized CAP patients, even in the second decade of the 21st century, even within a modern, tertiary medical center. Limitations This study is a retrospective analysis conducted in a single medical center, which may limit the generalizability of our findings. Several patients’ characteristics could not be drawn, as a reflection of the common clinical picture, e.g. we could not differentiate between pure viral and pure bacterial CAP. This was also the case during hospitalization, as reflected by the very high percentages of antibiotic treatments. Also, we did not include severity scoring systems since these were not commonly used / described during patients’ in-hospital stay in general / internal medicine departments. Furthermore, while we establish association between anemia and poor outcomes, causative relationships cannot be definitively ruled out, indicating further research is needed in a diverse population. Declarations Ethics approval and consent to participate: The study was approved by the Chaim Sheba Medical Center Institutional Review Board (IRB, approval # SMC-D-1250-24) in accordance with the declaration of Helsinki, and a waiver of informed consent was granted by the IRB due to the retrospective nature of this study. Consent for publication: All authors gave their approval for publication. Availability of data and materials: All research materials will be available at the request from the corresponding author and in accord to the IRB regulations. Competing interests: All authors declare no competing interests regarding this study and publication. Funding: The current study had no external funding to report. Authors' contributions: All authors significantly contributed to the design, analysis, data curation, draft and final manuscript writing. Acknowledgements: N/A References Reade MC, Weissfeld L, Angus DC, Kellum JA, Milbrandt EB. The prevalence of anemia and its association with 90-day mortality in hospitalized community-acquired pneumonia. BMC Pulm Med. 2010;10(1):15. SCHOORL M, SNIJDERS D, SCHOORL M, BOERSMA WG, BARTELS PCM. Temporary impairment of reticulocyte haemoglobin content in subjects with community-acquired pneumonia. Int J Lab Hematol. 2012;34(4):390–5. Schoorl M, Snijders D, Schoorl M, Boersma WG, Bartels PCM. Transient impairment of reticulocyte hemoglobin content and hepcidin-25 induction in patients with community-acquired pneumonia. Scand J Clin Lab Invest. 2013;73(1):54–60. Ren Q, Liu H, Wang Y, Dai D, Tian Z, Jiao G, et al. The Role of Red Blood Cell Distribution Width in the Severity and Prognosis of Community-Acquired Pneumonia. Can Respir J. 2021;2021:1–9. 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Anemia in Clinical Practice—Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015;52(4):261–9. Bordón J, Peyrani P, Brock GN, Blasi F, Rello J, File T, et al. The Presence of Pneumococcal Bacteremia Does Not Influence Clinical Outcomes in Patients With Community-Acquired Pneumonia. Chest. 2008;133(3):618–24. Tao Z, Xu J, Chen W, Yang Z, Xu X, Liu L, et al. Anemia is associated with severe illness in COVID-19: A retrospective cohort study. J Med Virol. 2021;93(3):1478–88. Randi ML, Bertozzi I, Santarossa C, Cosi E, Lucente F, Bogoni G, et al. Prevalence and Causes of Anemia in Hospitalized Patients: Impact on Diseases Outcome. J Clin Med. 2020;9(4):950. Ioannou P, Papazachariou A, Tsafaridou M, Koutroubakis IE, Kofteridis DP. Etiology of Anemia and Risk Factors of Mortality among Hospitalized Patients: A Real-Life Retrospective Study in a Tertiary Center in Greece. Hematol Rep. 2023;15(2):347–57. Roubinian NH, Murphy EL, Mark DG, Triulzi DJ, Carson JL, Lee C, et al. Long-Term Outcomes Among Patients Discharged From the Hospital With Moderate Anemia. Ann Intern Med. 2019;170(2):81. Xu Y, Fang J, Kang X, Xiang T. The U-shaped association between hemoglobin concentrations and all-cause death risk in patients with community-acquired pneumonia. Lab Med. 2024. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editor assigned by journal 21 Apr, 2025 Editorial decision: Revision requested 21 Apr, 2025 Reviews received at journal 13 Apr, 2025 Reviewers agreed at journal 11 Apr, 2025 Reviewers invited by journal 10 Apr, 2025 Submission checks completed at journal 07 Apr, 2025 First submitted to journal 05 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5701716","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441375054,"identity":"e72b2450-3bce-41d1-94e3-0aa18e26728e","order_by":0,"name":"Yehonatan Marziano","email":"","orcid":"","institution":"The Chaim Sheba Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yehonatan","middleName":"","lastName":"Marziano","suffix":""},{"id":441375055,"identity":"63f4877f-74dc-4b86-a770-3dfdeca7c6f6","order_by":1,"name":"Daniella Itzhak","email":"","orcid":"","institution":"Lithuanian University of Health 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Liran","middleName":"","lastName":"Glam","suffix":""},{"id":441375065,"identity":"6846d7fa-96d9-41ff-a8c5-5070fcb45c34","order_by":8,"name":"Gad Segal","email":"data:image/png;base64,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","orcid":"","institution":"The Chaim Sheba Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Gad","middleName":"","lastName":"Segal","suffix":""},{"id":441375066,"identity":"ef1945f5-383d-44da-8317-94d4766f5362","order_by":9,"name":"Reut Kassif Lerner","email":"","orcid":"","institution":"Safra Children’s Hospital, The Chaim Sheba Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Reut","middleName":"Kassif","lastName":"Lerner","suffix":""}],"badges":[],"createdAt":"2024-12-23 18:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5701716/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5701716/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-11744-2","type":"published","date":"2025-10-13T15:56:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80577887,"identity":"4fdb4f8d-67a9-4c15-8ecf-ce6114927246","added_by":"auto","created_at":"2025-04-14 23:00:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":105225,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow of patients.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5701716/v1/b3237facb3b77040cd093f4d.png"},{"id":80579347,"identity":"1fd4912b-6a6a-4306-9a9f-7df1703d6327","added_by":"auto","created_at":"2025-04-14 23:08:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":122395,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan Meier survival analysis – according to age groups.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5701716/v1/1988a9c2decacf4b0014eff2.png"},{"id":93955915,"identity":"5aa4cf66-628f-428f-ac2e-70ebd0a5b026","added_by":"auto","created_at":"2025-10-20 16:06:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":934035,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5701716/v1/9ddef3d5-3645-4ba7-8fd5-c87da13b7e8d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Profound Anemia in Hospitalized Community Acquired Pneumonia Patients is Associated with Increased Mortality and is Prevalent in All Patients’ Age-groups. A Retrospective Analysis of 15,121 Patients","fulltext":[{"header":"Background","content":"\u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnemia as a prevalent phenomenon in patients with pneumonia\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eCommunity-acquired pneumonia (CAP) is a common cause of hospitalization, affecting both healthy individuals and those with comorbidities. While the prevalence of anemia in critically ill patients is well-documented, its occurrence in hospitalized CAP patients without significant comorbidities or severe illness is less understood (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Schoorl M. et al., analyzed healthy subjects without known comorbidities who were hospitalized for CAP. They were investigated for changes in hematological laboratory values and parameters, particularly focusing on the development of anemia. The results demonstrated a decline in hemoglobin (Hb) levels, accompanied by low reticulocyte counts and a temporary impairment in hematopoiesis during the early stages of hospitalization, with a recovery of Hb and Reticulocytes to normal range values between days 4 and 14 of hospitalization during antibiotic treatment (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Previous studies have demonstrated that even among patients without known comorbidities, CAP can lead to the development of anemia, with declines in hemoglobin concentration and reticulocyte counts upon hospital admission (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These fluctuations suggest a transient impairment in iron utilization for hemoglobin synthesis during inflammation, potentially due to functional iron depletion (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Furthermore, some patients may present with anemia concurrent with pneumonia rather than pre-existing comorbidities (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Rease et al., showed that even among previously healthy subjects, the development of anemia during hospitalization was common (~\u0026thinsp;55% of subjects). When anemia was moderate to severe (\u0026le;\u0026thinsp;10 g/dL), its development was independently associated with increased 90 days mortality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Aside from the Hb concentration, higher red cell distribution width (RDW) values were found to be significantly correlated with increased severity of CAP, as reflected by higher Pneumonia Severity Index (PSI) and CURB-65 scores. Moreover, patients with higher RDW values experienced higher short-term mortality rates. Importantly, RDW values were not associated with anemia prior to admission, combining RDW with PSI and CURB-65 was found to improve the predictive performance for CAP 90-day mortality risk (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Another retrospective study by Braun et al., found that elevated RDW levels on admission of young patients (60 years old or younger) without known comorbidities suffering from CAP, were significantly associated with higher rates of mortality and complicated hospitalization (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMechanisms underlying the anemia development during pneumonia\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe mechanism underlying anemia in CAP involves, along other patho-physiologies, the dysregulation of hepcidin, an iron-regulatory hormone, which suppresses erythropoiesis and depletes iron stores during inflammation (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Parrow et al., at explored the sequestration and scavenging of iron during infection and elaborated on iron-related bacterial genes required to establish or maintain infection (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The development of anemia was found intricately tied to the body's response to infection. While not fully understood, extracellular pathogens like \u003cem\u003estreptococcus pneumoniae\u003c/em\u003e, may access ferritin released from damaged or lysed cells by virulence factors (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eAim of the current study\u003c/h3\u003e\n\u003cp\u003eThis retrospective analysis aims to comprehensively evaluate the prevalence and clinical implications of anemia in adults with CAP.. The primary objective was to determine whether, despite advancements in CAP treatment, anemia remains a significant negative prognostic factor for CAP patients in the second decade of the 21st century..\u003c/p\u003e "},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003ePatients cohort\u003c/h2\u003e \u003cp\u003ePatient data were retrieved from their electronic medical records. The inclusion criteria were a). age over 18 years, b). hospitalized patients admitted from the emergency department to hospital wards with a working diagnosis of pneumonia (based on various ICD-10 codes). The following data were collected: demographics (age, gender), chronic diagnoses and prespecified medications, and laboratory parameters during hospitalization. The following clinical outcomes were also documented: length of hospital stay (LOS) in days and mortality at 30, 60 and 90-days post hospitalization. Mortality events after hospital discharge were determined using the Israeli national population registry.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics: categorical values were described using numbers and percentages. Continuous variables were divided according to their distribution: normally distributed variables were described as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SD) while non-normally distributed variables were described as median and inter-quartile range (IQR).\u003c/p\u003e \u003cp\u003eAnalytic statistics: normality of variables was determined using Shapiro-Wilk test. Categorical variables were compared using the chi-square test. Continuous variables were compared using t-test, ANOVA or Kruskal-Wallis tests according to their distribution patterns. All tests regarded p-value lower than 5% as statistically significant. Tests were executed using Python Ver. 3.9.6.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e Following approval from the Chaim Sheba Medical Center Institutional Review Board (IRB, approval # SMC-D-1250-24) in accordance with the declaration of Helsinki, and a waiver of informed consent due to the retrospective nature of this study, patients\u0026rsquo; Electronic Medical Records (EMRs) were accessed, and clinical data were retrieved. The study included patients older than 18 years of age, that were admitted to the Chaim Sheba Medical Center, Israel\u0026rsquo;s largest tertiary medical center, between 2010 and 2024. We assumed that during this period no significant changes took place regarding the management of anemia in hospitalized, CAP patients. We retrieved data for 17,336 adult patients who were hospitalized due to Community-Acquired Pneumonia (CAP). After excluding 2,215 patients due to insufficient data (as shown in the CONSORT flow diagram, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), the final study cohort included 15,121 patients.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe median age of the entire cohort was 77 years (IQR 22.22), with 55.2% of the patients being males. The characteristics of the study cohort are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, categorized by anemia severity (Hb\u0026thinsp;\u0026gt;\u0026thinsp;10 g/dL, between 8 and 10 g/dL, and profound anemia defined as Hb\u0026thinsp;\u0026lt;\u0026thinsp;8 g/dL). Almost all patients were empirically treated by antibiotics due to the inherent difficulties in distinguishing between bacterial and viral CAP, especially upon patients\u0026rsquo; admission: antibiotics were given according to accepted guidelines (mostly by third generation cephalosporine and respiratory quinolone or macrolide). Female patients were more prevalent in the lower hemoglobin groups (43.9% amongst Hg\u0026thinsp;\u0026ge;\u0026thinsp;10g/dL, 49.6% in the 8g/dL\u0026thinsp;\u0026le;\u0026thinsp;Hb\u0026thinsp;\u0026lt;\u0026thinsp;10g/dL and 51.7% in the Hb\u0026thinsp;\u0026lt;\u0026thinsp;8g/dL group ; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Relating to patients\u0026rsquo; age, the median age was higher in the 8g/dL\u0026thinsp;\u0026le;\u0026thinsp;Hb\u0026thinsp;\u0026lt;\u0026thinsp;10g/dL group compared to the Hg\u0026thinsp;\u0026ge;\u0026thinsp;10g/dL group (78.6 years [IQR 18.4] vs. 76.7 years [IQR 22.9]), but surprisingly, the median age of patients with severe anemia was lower: 73.6 years [IQR 19.6], (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Background malignancy (both solid tumors and hematologic malignancies) were more common in the lower hemoglobin groups.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Patients\u0026rsquo; characteristics according to Hemoglobin concentrations.\u0026nbsp;\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003ePatient characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTotal cohort\u003c/p\u003e\n \u003cp\u003eN = 15,121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eHb \u0026lt; 8 gr/dL\u003c/p\u003e\n \u003cp\u003eN = 263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e8 gr/dL \u0026le; Hb \u0026lt; 10 gr/dL; N = 1,960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e10 gr/dL \u0026le; Hb\u003c/p\u003e\n \u003cp\u003eN = 12,898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; demographics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMale [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8,347 (55.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e127 (48.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e987 (50.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e7,233 (56.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eAge (Years; Median (IQR))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e77.01 (22.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e73.62 (19.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e78.64 (18.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e76.75 (22.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eBackground Diagnoses\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eDementia [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1,470\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e22\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(8.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e213 (10.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1,235 (9.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eDiabetes Mellitus [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3,476\u003c/p\u003e\n \u003cp\u003e(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e76\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e641 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2,759 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eIschemic Heart Disease [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3,188\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e58\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e510\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2,620 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMalignancy [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3,181\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e99\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(37.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e682 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2,400 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eCongestive Heart [N (%)] Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2,166\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(14.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e36\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e382 (19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1,748 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eCOPD [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1953\u003c/p\u003e\n \u003cp\u003e(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e24\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e250 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1679\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eChronic medications\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eSteroids [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cdiv align=\"center\"\u003e\u003c/div\u003e\n \u003cp\u003e606\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e22\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e111\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e473\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eProton pump inhibitor [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2143\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e60\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e452\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1631 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eChemotherapy [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e626\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e25\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e208 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e393\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 600px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMaximal CRP\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(mg/l; Median (IQR))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e148.59\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(150.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e166.35 (155.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e156.68 (140.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e146.57 (152.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMean Corpuscular Volume [fL (Median (IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e87.7\u003c/p\u003e\n \u003cp\u003e(7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e86.6\u003c/p\u003e\n \u003cp\u003e(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e86.5\u003c/p\u003e\n \u003cp\u003e(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e87.8\u003c/p\u003e\n \u003cp\u003e(7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eWhite blood cells [/mcl (Median (IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7,750\u003c/p\u003e\n \u003cp\u003e(4,700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e6,470\u003c/p\u003e\n \u003cp\u003e(5,670)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e7,190\u003c/p\u003e\n \u003cp\u003e(5,100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e7,870\u003c/p\u003e\n \u003cp\u003e(4,590)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003ePositive Blood Cultures [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e747\u003c/p\u003e\n \u003cp\u003e(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003cp\u003e(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e611\u003c/p\u003e\n \u003cp\u003e(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eFerritin [ng/ml (Median (IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e205.6\u003c/p\u003e\n \u003cp\u003e(365.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e380.2\u003c/p\u003e\n \u003cp\u003e(1051.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e228.9\u003c/p\u003e\n \u003cp\u003e(493.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e196.1\u003c/p\u003e\n \u003cp\u003e(330.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eIron [mcg/dL (Median (IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003cp\u003e(32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003cp\u003e(32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMinimal Albumin (g/dl; Median (IQR))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3.10\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2.60 (0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2.80 (0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e3.10 (0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMaximal Creatinine (mg/dl; Median (IQR))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.08\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1.30 (1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1.31 (1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1.05 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMaximal LDH (IU/l; Median (IQR))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e304.00\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(187.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e374.00 (291.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e318.50 (198.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e300.00 (183.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003ePlatelets [K/mcl; (Median (IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003cp\u003e(113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003cp\u003e(201)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003cp\u003e(150.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003cp\u003e(108)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eAlanine amino transferase [IU/L; (Median (IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eTreated with antibiotics [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e14,594\u003c/p\u003e\n \u003cp\u003e(96.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003cp\u003e(97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1,915\u003c/p\u003e\n \u003cp\u003e(97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e12,424\u003c/p\u003e\n \u003cp\u003e(96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eLength of hospital Stay (LOS; days); Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2.61\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e3.79 (6.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e3.53 (5.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2.50 (3.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eNecessitated Mechanical Ventilation [N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e370\u003c/p\u003e\n \u003cp\u003e(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003cp\u003e(8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003cp\u003e(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e273\u003c/p\u003e\n \u003cp\u003e(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMortality at 30-days\u003c/p\u003e\n \u003cp\u003e[N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2,070\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003cp\u003e(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e424\u003c/p\u003e\n \u003cp\u003e(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1,586\u003c/p\u003e\n \u003cp\u003e(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMortality at 60-days\u003c/p\u003e\n \u003cp\u003e[N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e599\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e30\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e120\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e449\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eMortality at 90-days\u003c/p\u003e\n \u003cp\u003e[N (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e393\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e88\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e292\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e describe the survival analysis for three hemoglobin concentrations in both age groups (above and below 65 years). It is evident that in both age groups, lower hemoglobin levels are associated with higher mortality rates. Furthermore, it is also evident that the mortality burden was lower amongst the younger age group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe role of younger age remained surprising in further analyses. As presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, detailing patient characteristics according to age groups, while older age was more prevalent in the two higher Hb groups, amongst patients who suffered from severe anemia (Hb\u0026thinsp;\u0026lt;\u0026thinsp;8g/dL) both age groups accounted for the same percentages (1.74%,p\u0026thinsp;=\u0026thinsp;NS). Even though younger age did not reduce the prevalence of severe anemia, it did serve as a protective patient characteristic relating to 30-, 60- and 90-days mortality.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients\u0026rsquo; characteristics according to age group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;65 years\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;4,091\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;65 years\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;11,030\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP - value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb\u0026thinsp;\u0026gt;\u0026thinsp;10 g/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e445 (10.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1778 (16.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 g/dL\u0026thinsp;\u0026lt;\u0026thinsp;Hb\u0026thinsp;\u0026lt;\u0026thinsp;10 g/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e374 (9.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1586 (14.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 g/dL\u0026thinsp;\u0026lt;\u0026thinsp;Hb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (1.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 (1.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNecessitated Mechanical Ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e283 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital Stay \u003c/p\u003e \u003cp\u003e(days; median (IQR))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.99 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.78 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality at 30 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e204 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,866 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality at 60 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (1.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e531 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality at 90 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (1.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e347 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn a univariate analysis presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, of the following patient characteristics were found to be statistically associated with an increased risk of 30-days mortality: age over 65 years (HR\u0026thinsp;=\u0026thinsp;3.88 (3.34\u0026ndash;4.5); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, dementia (HR\u0026thinsp;=\u0026thinsp;3.45 (95% CI 3.05\u0026ndash;3.89); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), hemoglobin between 8 to 10 gr/dL (HR\u0026thinsp;=\u0026thinsp;1.93 (95% CI 1.71\u0026ndash;2.18); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), hemoglobin lower than 8 gr/dL (HR\u0026thinsp;=\u0026thinsp;1.89 (95% CI 1.41\u0026ndash;2.53); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), past chemotherapy treatment (HR\u0026thinsp;=\u0026thinsp;1.82 (95% CI 1.5\u0026ndash;2.21); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), renal failure (HR\u0026thinsp;=\u0026thinsp;1.67 (95% CI 1.5\u0026ndash;1.86); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), malignancy (HR\u0026thinsp;=\u0026thinsp;1.66 (95% CI 1.49\u0026ndash;1.84); P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), arterial hypertension (HR\u0026thinsp;=\u0026thinsp;1.64 (95% CI 1.49\u0026ndash;1.8); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and diabetes mellitus (HR\u0026thinsp;=\u0026thinsp;1.23 (95% CI 1.11\u0026ndash;1.37); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In contrast, chronic obstructive pulmonary disease (COPD) and hemoglobin levels higher than 10 gr/dL were found to be relatively protective (HR\u0026thinsp;=\u0026thinsp;0.84 (95% CI 0.73\u0026ndash;0.97); p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and HR\u0026thinsp;=\u0026thinsp;0.5 (95% CI 0.45\u0026ndash;0.56); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis for 30 - days mortality.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u0026rsquo; characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP - Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.88 (3.34\u0026ndash;4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.45 (3.05\u0026ndash;3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 gr/dL\u0026thinsp;\u0026le;\u0026thinsp;hemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;10 gr/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.93 (1.71\u0026ndash;2.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;8 gr/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.89 (1.41\u0026ndash;2.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive blood cultures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.73 (1.44\u0026ndash;2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated with antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.47 (1.1\u0026ndash;1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.82 (1.5\u0026ndash;2.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.67 (1.5\u0026ndash;1.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.66 (1.49\u0026ndash;1.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.64 (1.49\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.23 (1.11\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.73\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u0026thinsp;\u0026ge;\u0026thinsp;10 gr/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5 (0.45\u0026ndash;0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents a multivariate analysis of patient characteristics that remained of statistical significance in relation to the risk of 30-days mortality. This analysis found that both severe anemia and advanced age were independently associated with increased risk of 30-days mortality (HR\u0026thinsp;=\u0026thinsp;1.8 (95% CI 1.33\u0026ndash;2.44); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and HR\u0026thinsp;=\u0026thinsp;3.23 (95% CI 2.76\u0026ndash;3.78); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis for 30 - days mortality.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u0026rsquo; characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP - Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.2 (2.73\u0026ndash;3.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.8 (2.46\u0026ndash;3.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;8 g/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.79 (1.32\u0026ndash;2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive blood cultures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.47 (1.22\u0026ndash;1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreated with antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1 (0.82\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.77 (1.42\u0026ndash;2.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.49 (1.32\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.23 (1.1\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.91\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of anemia in hospitalized patients with CAP varies depending on the definition used. According to the World Health Organization (WHO), anemia is defined as hemoglobin levels of less than 13 g/dL in men, and less than 12 g/dL in women (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In our study, we applied a cutoff of 10 g/dL for both genders to assess anemia prevalence in hospitalized CAP patients. We categorized patients into three groups based on hemoglobin concentrations: those with hemoglobin levels above 10 g/dL, those between 8 and 10 g/dL, and those with severe anemia, defined as having hemoglobin levels below 8 g/dL. Previous large inpatient CAP studies, such as the one by Bordon et al., defined anemia as hemoglobin of \u0026lt;\u0026thinsp;10 g/dL or hematocrit\u0026thinsp;\u0026lt;\u0026thinsp;30%, yielding a prevalence of anemia at presentation ranging from 7 to12% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Tao et al. found in their retrospective study, that anemia is common among patients suffering from pneumonia, with prevalence rates of 7%-12% in community-acquired pneumonia and 31.8% in severe influenza A (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Our study revealed a substantial prevalence of anemia among hospitalized patients with CAP, with a median age of 77 years, consistent with previous literature, showing that older adults are more susceptible to anemia due to various factors, including chronic diseases and nutritional deficiencies (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Additionally, our results showed a higher prevalence of anemia in female patients, which aligns with existing literature (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnemia has been widely recognized as a significant risk factor for poor outcomes hospitalized elderly patients (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Roubinian et al. demonstrated that anemia is consistently associated with prolonged hospital stays and is independently linked to both short- and long-term morbidity and mortality (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study found that severe anemia (Hb\u0026thinsp;\u0026lt;\u0026thinsp;8 g/dL) is a significant independent predictor of mortality in hospitalized CAP patients, especially in older individuals. The 30-day mortality rate was significantly higher in the severe anemia group (23%) compared to those with moderate anemia (22%), or those without anemia (12%). The Kaplan-Meier survival analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) revealed a clear trend: lower Hb levels were consistently associated with higher mortality rates across all age groups. However, patients over 65 years had a higher 30-day mortality rate (16.9%) compared those under 65 years (5%). These findings are consistent with prior research, such as Reade et al., which found a clear link between moderate to severe anemia and increased mortality in CAP patients, particularly in older populations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite previous findings, our study is unique in showing that the prevalence of severe anemia in CAP patients was equally frequent in those below and above 65 years of age, with severe anemia serving as an independent risk factor for poor clinical outcomes. Our unexpected finding was that patients with severe anemia (Hb\u0026thinsp;\u0026lt;\u0026thinsp;8 g/dL) had a lower median age (73.6 years) compared to those with moderate anemia (8 g/dL\u0026thinsp;\u0026lt;\u0026thinsp;Hb\u0026thinsp;\u0026lt;\u0026thinsp;10 gr/dL), whose median age was 78.6 years, and those with mild anemia (10 g/dL\u0026thinsp;\u0026lt;\u0026thinsp;Hb), whose median age was 76.75 years. Both younger and older age groups had the same prevalence of severe anemia, with 1.7% of patients in each group exhibiting hemoglobin levels below 8 g/dL. These findings should be even more surprising in light of the fact that older patients had, most probably, higher prevalence of chronic co-morbidities.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe authors of this manuscript would like to emphasize the significance of our findings. Our results challenge the assumption that younger, healthier individuals are less vulnerable to anemia in the context of CAP, challenging the common perception that severe anemia primarily affects older patients. Profound anemia affects hospitalized CAP patients below and above the age of 65 years and should be considered as an independent risk factor for patients\u0026rsquo; mortality regardless of patient age. Furthermore, we assert that anemia remains a major risk factor for mortality in hospitalized CAP patients, even in the second decade of the 21st century, even within a modern, tertiary medical center.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study is a retrospective analysis conducted in a single medical center, which may limit the generalizability of our findings. Several patients\u0026rsquo; characteristics could not be drawn, as a reflection of the common clinical picture, e.g. we could not differentiate between pure viral and pure bacterial CAP. This was also the case during hospitalization, as reflected by the very high percentages of antibiotic treatments. Also, we did not include severity scoring systems since these were not commonly used / described during patients\u0026rsquo; in-hospital stay in general / internal medicine departments. Furthermore, while we establish association between anemia and poor outcomes, causative relationships cannot be definitively ruled out, indicating further research is needed in a diverse population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Chaim Sheba Medical Center Institutional Review Board (IRB, approval # SMC-D-1250-24) in accordance with the declaration of Helsinki, and a waiver of informed consent was granted by the IRB due to the retrospective nature of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors gave their approval for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll research materials will be available at the request from the corresponding author and in accord to the IRB regulations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors declare no competing interests regarding this study and publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe current study had no external funding to report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors significantly contributed to the design, analysis, data curation, draft and final manuscript writing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eN/A\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eReade MC, Weissfeld L, Angus DC, Kellum JA, Milbrandt EB. The prevalence of anemia and its association with 90-day mortality in hospitalized community-acquired pneumonia. BMC Pulm Med. 2010;10(1):15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSCHOORL M, SNIJDERS D, SCHOORL M, BOERSMA WG, BARTELS PCM. Temporary impairment of reticulocyte haemoglobin content in subjects with community-acquired pneumonia. Int J Lab Hematol. 2012;34(4):390\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchoorl M, Snijders D, Schoorl M, Boersma WG, Bartels PCM. Transient impairment of reticulocyte hemoglobin content and hepcidin-25 induction in patients with community-acquired pneumonia. Scand J Clin Lab Invest. 2013;73(1):54\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen Q, Liu H, Wang Y, Dai D, Tian Z, Jiao G, et al. The Role of Red Blood Cell Distribution Width in the Severity and Prognosis of Community-Acquired Pneumonia. Can Respir J. 2021;2021:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGe Y, Liu C, Rana M, Zhu X, Wang N, Xu J et al. Elevated Red Blood Cell Distribution Width Combined White Blood Cell in Peripheral Blood Routine Have a Better Sensitivity than CURB-65 Scores in Predicting ICU Admission and Mortality in Adult Community-Acquired Pneumonia Patients. Clin Lab. 2019;65(03/2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun E, Domany E, Kenig Y, Mazor Y, Makhoul BF, Azzam ZS. Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia. Crit Care. 2011;15(4):R194.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBudnevsky AV, Esaulenko IE, Ovsyannikov ES, Labzhaniya NB, Voronina EV, Chernov AV. [ANEMIC SYNDROME IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA]. Klin Med (Mosk). 2016;94(1):56\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParrow NL, Fleming RE, Minnick MF. Sequestration and scavenging of iron in infection. Infect Immun. 2013;81(10):3503\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta R, Shah P, Swiatlo E. Differential gene expression in Streptococcus pneumoniae in response to various iron sources. Microb Pathog. 2009;47(2):101\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDomenica Cappellini M, Motta I. Anemia in Clinical Practice\u0026mdash;Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015;52(4):261\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBord\u0026oacute;n J, Peyrani P, Brock GN, Blasi F, Rello J, File T, et al. The Presence of Pneumococcal Bacteremia Does Not Influence Clinical Outcomes in Patients With Community-Acquired Pneumonia. Chest. 2008;133(3):618\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTao Z, Xu J, Chen W, Yang Z, Xu X, Liu L, et al. Anemia is associated with severe illness in COVID-19: A retrospective cohort study. J Med Virol. 2021;93(3):1478\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRandi ML, Bertozzi I, Santarossa C, Cosi E, Lucente F, Bogoni G, et al. Prevalence and Causes of Anemia in Hospitalized Patients: Impact on Diseases Outcome. J Clin Med. 2020;9(4):950.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIoannou P, Papazachariou A, Tsafaridou M, Koutroubakis IE, Kofteridis DP. Etiology of Anemia and Risk Factors of Mortality among Hospitalized Patients: A Real-Life Retrospective Study in a Tertiary Center in Greece. Hematol Rep. 2023;15(2):347\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoubinian NH, Murphy EL, Mark DG, Triulzi DJ, Carson JL, Lee C, et al. Long-Term Outcomes Among Patients Discharged From the Hospital With Moderate Anemia. Ann Intern Med. 2019;170(2):81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Y, Fang J, Kang X, Xiang T. The U-shaped association between hemoglobin concentrations and all-cause death risk in patients with community-acquired pneumonia. Lab Med. 2024.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anemia, Community Acquired Pneumonia, Mortality, Age, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-5701716/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5701716/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground.\u003c/h2\u003e \u003cp\u003eCommunity acquired Pneumonia (CAP) is a widespread and potentially lethal disease. Acute anemia is a common phenomenon featuring many such instances. However, the prevalence and clinical implications of anemia in younger CAP patients is unknown. This study aimed to assess the prevalence and clinical outcomes of anemia in patients with CAP treated in a modern-time treated CAP (with current treatment strategies?).\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e \u003cp\u003eThis was a retrospective analysis of CAP patients that were hospitalized during 2010\u0026ndash;2024 in a large, tertiary medical center.\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e \u003cp\u003eFollowing approval by the Institutional Review Board, we retrieved data relating to 17,336 adult patients hospitalized with CAP, of whom relevant clinical data were available for 15,121 patients. The median age was 77 years (IQR 22.2) and 55.2% of the cohort were males. Female patients were more common in the lower hemoglobin patients\u0026rsquo; groups (43.9% amongst Hg\u0026thinsp;\u0026ge;\u0026thinsp;10g/dL, 49.6% in the 8g/dL\u0026thinsp;\u0026le;\u0026thinsp;Hb\u0026thinsp;\u0026lt;\u0026thinsp;10g/dL group and 51.7% in the Hb\u0026thinsp;\u0026lt;\u0026thinsp;8g/dL group of patients; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Interestingly, the median age of patients with severe anemia (73.6 years [IQR 19.6]) was lower than that of the other groups: 78.6 [IQR 18.4] in the 8g/dL\u0026thinsp;\u0026le;\u0026thinsp;Hb\u0026thinsp;\u0026lt;\u0026thinsp;10g/dL group and 76.7 [IQR 22.9] in the Hg\u0026thinsp;\u0026ge;\u0026thinsp;10g/dL group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Profound anemia and advanced age were identified as independent risk factors for both short- and long-term mortality.\u003c/p\u003e\u003ch2\u003eConclusions.\u003c/h2\u003e \u003cp\u003eProfound anemia affects hospitalized CAP patients across all age groups and remains an independent risk factor for adverse clinical outcomes in the second decade of the 21st century.\u003c/p\u003e","manuscriptTitle":"Profound Anemia in Hospitalized Community Acquired Pneumonia Patients is Associated with Increased Mortality and is Prevalent in All Patients’ Age-groups. 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