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Hemoglobin levels and multidomain geriatric impairment in older outpatients: a comprehensive geriatric assessment study
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DOI：10.1186/s12877-026-08110-5.png)
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Abstract
En 中文
This study investigated the associations between hemoglobin (Hb) levels and comprehensive geriatric assessment (CGA) parameters in patients aged ≥ 60 years and explored the ability of Hb concentration to discriminate concurrent CGA-defined impairments. In this retrospective cross-sectional study conducted at a tertiary care geriatric outpatient clinic in Türkiye (May 2023–December 2025), 432 patients were included after applying exclusion criteria. All patients underwent a routine CGA protocol, although the availability of individual assessment components varied. Separate binary logistic regression models were used to evaluate associations between hemoglobin concentration, entered as a continuous predictor, and predefined CGA-defined impairments entered as binary outcomes. Extended sensitivity models additionally accounted for comorbidity burden, renal function, and inflammation, and the Benjamini–Hochberg procedure was applied to address multiple testing. Exploratory ROC analyses were conducted for the outcomes showing nominally significant associations in the age-, sex-, and iron deficiency-adjusted models. The median age was 78 years (range: 60–99); 62.5% were female, and 32.4% had anemia according to World Health Organization criteria. Patients with anemia had higher comorbidity burden, lower handgrip strength and gait speed, poorer nutritional status, and greater functional dependency and frailty. After adjustment for age, sex, and iron deficiency, each 1-g/dL higher hemoglobin concentration was associated with lower odds of frailty (OR: 0.653, 95% CI: 0.481–0.889), IADL dependency (OR: 0.738, 95% CI: 0.598–0.911), and malnutrition risk (OR: 0.871, 95% CI: 0.771–0.985), but not with the remaining CGA-defined outcomes. These three associations remained nominally significant in extended sensitivity models. After false discovery rate correction across the 13 primary models, frailty and IADL dependency remained statistically significant, whereas malnutrition risk did not. The AUCs were 0.726 (95% CI: 0.633–0.819) for frailty and 0.698 (95% CI: 0.625–0.770) for IADL dependency; however, these exploratory ROC analyses provided limited clinically interpretable information because of marked class imbalance and the small numbers of participants without the respective impairments. Lower hemoglobin concentrations were associated with concurrent frailty and IADL dependency after adjustment for age, sex, and iron deficiency, with a weaker association with malnutrition risk. Hemoglobin should be interpreted as a marker of multidomain geriatric vulnerability rather than as a stand-alone screening or diagnostic test.
Keywords:
Anemia
Hemoglobin
Comprehensive Geriatric Assessment
Frailty
Sarcopenia
Malnutrition
Functional Dependency
ROC Analysis
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