Anemia and treatment response in pneumonia at high altitude: a cohort in Quito Anemia and pneumonia at high altitude

Abstract

Introduction: Community-acquired pneumonia (CAP) remains a relevant cause of morbidity and mortality in developing countries. At high altitude, environmental hypoxia and anemia may reduce tissue oxygenation and worsen the clinical course. Objective: To evaluate the impact of anemia on clinical course and treatment response in children hospitalized with CAP at 2,850 m above sea level in Quito, Ecuador.

Materials and Methods: Prospective cohort (December 2022–March 2023) including 215 patients aged 2 months to 14 years with CAP. Anemia was defined as hemoglobin <11 g/dL adjusted for altitude (–1.3 g/dL). The primary outcome was duration of oxygen therapy; secondary outcomes were therapeutic failure and length of hospital stay. Mixed-effects linear models, the Wilcoxon test, and Fisher’s exact test were used.

Results: Anemia prevalence was 44.7%. Children with anemia were younger and had lower weight/height (p<0.001) and lower hemoglobin levels (9.70±1.10 vs 12.10±0.80 g/dL; p<0.001). There were no differences in initial clinical presentation or radiographic findings. Oxygen therapy duration was longer in the anemia group (78.64±53.98 vs 62.68±42.39 hours; p=0.040), and hospital stay showed a trend toward being longer (4.11±2.31 vs 3.48±1.81 days; p=0.060). No differences were observed in therapeutic failure.

Conclusions: In this high-altitude cohort, anemia was frequent and was associated with longer oxygen therapy duration and a trend toward longer hospital stay, suggesting that anemia could be a clinically modifiable factor in children hospitalized with CAP.