Iron deficiency anemia was associated with lower in-hospital mortality among ARDS patients, particularly in Black (aOR 0.64; P<0.001) and Hispanic (aOR 0.70; P=0.004) populations.
Observational (n=140,060)
Yes
Does Iron Deficiency Anemia impact in-hospital mortality in adult patients with ARDS across different racial subgroups?
Iron deficiency anemia in ARDS patients is paradoxically associated with improved in-hospital survival, particularly in Black and Hispanic populations, despite increased transfusion requirements.
Effect estimate: aOR 0.78 (White), 0.64 (Black), 0.70 (Hispanic) (95% CI 0.64-0.95 (White), 0.50-0.81 (Black), 0.55-0.89 (Hispanic))
p-value: p=0.013 (White), <0.001 (Black), 0.004 (Hispanic)
Abstract Rationale Iron plays a critical role in oxygen transport, immune regulation, and cellular metabolism. The relationship between iron deficiency and the clinical outcomes of Acute Respiratory Distress Syndrome (ARDS) has not been thoroughly studied. While prior analyses demonstrated that Iron Deficiency Anemia (IDA) is associated with improved in-hospital outcomes among ARDS patients, racial variations in this relationship remain unclear. This study examines the impact of IDA on ARDS outcomes across racial subgroups using real-world national data. Methods A retrospective analysis was conducted using the National Inpatient Sample Database (2016-2019), which provides a representative sample of U.S. hospital discharges. Adult patients with ARDS were identified by ICD-10 codes and stratified by the presence of IDA. Each IDA patient was propensity-matched (1:8) to ARDS patients without IDA using multivariate logistic regression adjusting for age, sex, race, Charlson Comorbidity Index, insurance, income, and hospital characteristics (bed size, location, and teaching status). Race-stratified multivariable logistic regression models were used to evaluate in-hospital mortality and transfusion requirements. Results Among 140,060 ARDS patients, 7,390 (5.3%) had IDA. Racial distribution included 60.4% White, 19.2% Black, 14.1% Hispanic, 3.2% Asian/Pacific Islander, and 3.1% Other. IDA was associated with lower in-hospital mortality among White (aOR 0.78, 95% CI 0.64-0.95, p = 0.013), Black (aOR 0.64, 95% CI 0.50-0.81, p 0.001), and Hispanic (aOR 0.70, 95% CI 0.55-0.89, p = 0.004) patients. Asian/Pacific Islander and Other groups exhibited similar directional trends (aOR 0.85, 95% CI 0.61-1.19, p = 0.34; aOR 0.91, 95% CI 0.66-1.24, p = 0.55, respectively) that did not reach statistical significance. Across all racial groups, IDA was associated with increased transfusion requirements (aOR range 2.05-2.73, all p ≤ 0.002). No significant differences were observed in acute kidney injury, vasopressor use, or arrhythmias. Conclusion IDA was associated with improved survival among ARDS patients, particularly in Black and Hispanic populations, while similar but statistically insignificant trends were seen in Asian and Other groups. These findings highlight complex race-specific interactions between iron metabolism and ARDS pathophysiology, underscoring the need for further investigation into the biological and social determinants influencing these disparities. This abstract is funded by: None
Gisellie et al. (Fri,) conducted a observational in Acute Respiratory Distress Syndrome (ARDS) (n=140,060). Iron Deficiency Anemia (IDA) vs. No Iron Deficiency Anemia was evaluated on In-hospital mortality (aOR 0.78 (White), 0.64 (Black), 0.70 (Hispanic), 95% CI 0.64-0.95 (White), 0.50-0.81 (Black), 0.55-0.89 (Hispanic), p=0.013 (White), <0.001 (Black), 0.004 (Hispanic)). Iron deficiency anemia was associated with lower in-hospital mortality among ARDS patients, particularly in Black (aOR 0.64; P<0.001) and Hispanic (aOR 0.70; P=0.004) populations.
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