Hemoglobin predicts mortality risk in geriatric patients with dysphagia: a Japanese retrospective cohort study

Background Hemoglobin (Hb) is an established prognostic biomarker in several conditions, but its prognostic value in elderly patients with dysphagia is unclear. Objective To evaluate whether Hb concentration predicts all-cause mortality in Japanese geriatric patients with dysphagia. Methods We performed a retrospective secondary analysis of a publicly available Japanese cohort (Dryad; n = 253; Jan 2014–Jan 2017). Hemoglobin measured ≤7 days before nutritional support initiation was analyzed as a continuous variable and by tertiles (T1 < 9 g/dL; T2 9–12 g/dL; T3 ≥ 12 g/dL). Cox proportional hazards models estimated associations (Models I–III: unadjusted to fully adjusted). Survival probabilities were assessed by Kaplan–Meier analysis; subgroup interactions were tested. Results Median age was 83 years ( n = 253; 154 females). In multivariable analysis Hb (per 1 g/dL) was independently associated with lower mortality (adjusted HR = 0.83; 95% CI: 0.76–0.91; p < 0.001). Compared with T1, adjusted HRs were 0.62 (95% CI: 0.41–0.93; p = 0.021) for T2 and 0.36 (95% CI: 0.21–0.60; p < 0.001) for T3. Median survival increased across tertiles (T1:185 days; T2:309 days; T3:405 days; log-rank p < 0.001). No significant subgroup interactions were observed. Conclusion Higher hemoglobin concentration was independently associated with lower mortality risk in this Japanese cohort of hospitalized geriatric patients with advanced dysphagia requiring artificial nutrition, supporting routine Hb monitoring to inform nutritional and prognostic care.