Red blood cell transfusion in septic shock: clinical characteristics and outcome of unselected patients in a prospective, multicentre cohort

TY - JOUR

T1 - Red blood cell transfusion in septic shock

T2 - clinical characteristics and outcome of unselected patients in a prospective, multicentre cohort

AU - Rosland, Ragnhild G

AU - Hagen, Marte U

AU - Haase, Nicolai

AU - Holst, Lars B

AU - Plambech, Morten

AU - Madsen, Kristian R

AU - Søe-Jensen, Peter

AU - Poulsen, Lone M

AU - Bestle, Morten

AU - Perner, Anders

PY - 2014/2/27

Y1 - 2014/2/27

N2 - BACKGROUND: Treating anaemia with red blood cell (RBC) transfusion is frequent, but controversial, in patients with septic shock. Therefore we assessed characteristics and outcome associated with RBC transfusion in this group of high risk patients.METHODS: We did a prospective cohort study at 7 general intensive care units (ICUs) including all adult patients with septic shock in a 5-month period.RESULTS: Ninety-five of the 213 included patients (45%) received median 3 (interquartile range 2-5) RBC units during shock. The median pre-transfusion haemoglobin level was 8.1 (7.4-8.9) g/dl and independent of shock day and bleeding. Patients with cardiovascular disease were transfused at higher haemoglobin levels. Transfused patients had higher Simplified Acute Physiology Score (SAPS) II (56 (45-69) vs. 48 (37-61), p = 0.0005), more bleeding episodes, lower haemoglobin levels days 1 to 5, higher Sepsis-related Organ Failure Assessment (SOFA) scores (days 1 and 5), more days in shock (5 (3-10) vs. 2 (2-4), p = 0.0001), more days in ICU (10 (4-19) vs. 4 (2-8), p = 0.0001) and higher 90-day mortality (66 vs. 43%, p = 0.001). The latter association was lost after adjustment for admission category and SAPS II and SOFA-score on day 1.CONCLUSIONS: The decision to transfuse patients with septic shock was likely affected by disease severity and bleeding, but haemoglobin level was the only measure that consistently differed between transfused and non-transfused patients.

AB - BACKGROUND: Treating anaemia with red blood cell (RBC) transfusion is frequent, but controversial, in patients with septic shock. Therefore we assessed characteristics and outcome associated with RBC transfusion in this group of high risk patients.METHODS: We did a prospective cohort study at 7 general intensive care units (ICUs) including all adult patients with septic shock in a 5-month period.RESULTS: Ninety-five of the 213 included patients (45%) received median 3 (interquartile range 2-5) RBC units during shock. The median pre-transfusion haemoglobin level was 8.1 (7.4-8.9) g/dl and independent of shock day and bleeding. Patients with cardiovascular disease were transfused at higher haemoglobin levels. Transfused patients had higher Simplified Acute Physiology Score (SAPS) II (56 (45-69) vs. 48 (37-61), p = 0.0005), more bleeding episodes, lower haemoglobin levels days 1 to 5, higher Sepsis-related Organ Failure Assessment (SOFA) scores (days 1 and 5), more days in shock (5 (3-10) vs. 2 (2-4), p = 0.0001), more days in ICU (10 (4-19) vs. 4 (2-8), p = 0.0001) and higher 90-day mortality (66 vs. 43%, p = 0.001). The latter association was lost after adjustment for admission category and SAPS II and SOFA-score on day 1.CONCLUSIONS: The decision to transfuse patients with septic shock was likely affected by disease severity and bleeding, but haemoglobin level was the only measure that consistently differed between transfused and non-transfused patients.

KW - APACHE

KW - Aged

KW - Anemia

KW - Erythrocyte Transfusion

KW - Female

KW - Follow-Up Studies

KW - Hemoglobins

KW - Humans

KW - Intensive Care Units

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Risk Factors

KW - Shock, Septic

KW - Treatment Outcome

U2 - 10.1186/1757-7241-22-14

DO - 10.1186/1757-7241-22-14

M3 - Journal article

C2 - 24571858

SN - 1757-7241

VL - 22

SP - 14

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

ER -