Intravenous iron to treat anaemia following critical care: a multicentre feasibility randomised trial

• Published in: British journal of anaesthesia : BJA Vol. 128; no. 2; p. 272
• Main Authors: Shah, Akshay, Chester-Jones, Mae, Dutton, Susan J, Marian, Ioana R, Barber, Vicki S, Griffith, David M, Singleton, Jo, Wray, Katherine, James, Tim, Drakesmith, Hal, Robbins, Peter A, Frise, Matthew C, Young, J Duncan, Walsh, Timothy S, McKechnie, Stuart R, Stanworth, Simon J
• Format: Journal Article
• Language: English
• Published: England 01-02-2022
• Subjects: Administration, Intravenous; Adolescent; Adult; Aged; Aged, 80 and over; Anemia - drug therapy; Critical Care; Feasibility Studies; Female; Ferric Compounds - administration & dosage; Follow-Up Studies; Hematinics - administration & dosage; Hemoglobins - analysis; Humans; Length of Stay; Male; Maltose - administration & dosage; Maltose - analogs & derivatives; Middle Aged; Patient Readmission - statistics & numerical data; Patient Reported Outcome Measures; Young Adult; intravenous iron; critical care; randomised controlled trial; anaemia; outcomes
• ISSN: 1471-6771
• DOI: 10.1016/j.bja.2021.11.010

Anaemia is common and associated with poor outcomes in survivors of critical illness. However, the optimal treatment strategy is unclear.
We conducted a multicentre, feasibility RCT to compare either a single dose of ferric carboxymaltose 1000 mg i.v. or usual care in patients being discharged from the ICU with moderate or severe anaemia (haemoglobin ≤100 g L
). We collected data on feasibility (recruitment, randomisation, follow-up), biological efficacy, and clinical outcomes.
Ninety-eight participants were randomly allocated (49 in each arm). The overall recruitment rate was 34% with 6.5 participants recruited on average per month. Forty-seven of 49 (96%) participants received the intervention. Patient-reported outcome measures were available for 79/93 (85%) survivors at 90 days. Intravenous iron resulted in a higher mean (standard deviation [sd]) haemoglobin at 28 days (119.8 [13.3] vs 106.7 [14.9] g L
) and 90 days (130.5 [15.1] vs 122.7 [17.3] g L
), adjusted mean difference (10.98 g L
; 95% confidence interval [CI], 4.96-17.01; P<0.001) over 90 days after randomisation. Infection rates were similar in both groups. Hospital readmissions at 90 days post-ICU discharge were lower in the i.v. iron group (7/40 vs 15/39; risk ratio=0.46; 95% CI, 0.21-0.99; P=0.037). The median (inter-quartile range) post-ICU hospital stay was shorter in the i.v. iron group but did not reach statistical significance (5.0 [3.0-13.0] vs 9.0 [5.0-16.0] days, P=0.15).
A large, multicentre RCT of i.v. iron to treat anaemia in survivors of critical illness appears feasible and is necessary to determine the effects on patient-centred outcomes.
ISRCTN13721808 (www.isrctn.com).