Epidemiology of Massive Transfusion: A Binational Study From Sweden and Denmark

Märit Halmin; Flaminia Chiesa; Senthil K Vasan; Agneta Wikman; Rut Norda; Klaus Rostgaard; Ole Birger Vesterager Pedersen; Christian Erikstrup; Kaspar Rene Nielsen; Kjell Titlestad; Henrik Ullum; Henrik Hjalgrim; Gustaf Edgren

doi:10.1097/CCM.0000000000001410

Epidemiology of Massive Transfusion: A Binational Study From Sweden and Denmark

Märit Halmin, Flaminia Chiesa, Senthil K Vasan, Agneta Wikman, Rut Norda, Klaus Rostgaard, Ole Birger Vesterager Pedersen, Christian Erikstrup, Kaspar Rene Nielsen, Kjell Titlestad, Henrik Ullum, Henrik Hjalgrim, Gustaf Edgren

Department of Clinical Medicine

35 Citations (Scopus)

Abstract

There is an increasing focus on massive transfusion, but there is a paucity of comprehensive descriptions of the massively transfused patients and their outcomes. The objective of this study is to describe the incidence rate of massive transfusion, patient characteristics, and the mortality of massively transfused patients. Design: Descriptive cohort study. Setting: Nationwide study with data from Sweden and Denmark. Patients: The study was based on the Scandinavian Donations and Transfusions database, including all patients receiving 10 or more red cell concentrate transfusions in Sweden from 1987 and in Denmark from 1996. A total of 92,057 patients were included. Patients were followed until the end of 2012. Measurements and Main Results: Descriptive statistics were used to characterize the patients and indications. Post transfusion mortality was expressed as crude 30-day mortality and as long-term mortality using the Kaplan-Meier method and using standardized mortality ratios. The incidence of massive transfusion was higher in Denmark (4.5 per 10,000) than in Sweden (2.5 per 10,000). The most common indication for massive transfusion was major surgery (61.2%) followed by trauma (15.4%). Massive transfusion due to obstetrical bleeding constituted only 1.8%. The overall 5-year mortality was very high (54.6%), however with large differences between indication groups, ranging from 91.1% among those transfused for a malignant disease without surgery to 1.7% among patients transfused for obstetrical bleeding. The early standardized mortality ratios were high and decreased thereafter, but remained elevated throughout the time period. Conclusions: This large-scale study based on nationwide data from Sweden and Denmark describes the complete range of massive transfusion. We report a nonnegligible incidence and both a high absolute mortality and high standardized mortality ratio. The general pattern was similar for Sweden and Denmark, and we believe that similar patterns may be found in other high-resource countries. The study provides a relevant background for clinicians and researchers for designing future studies in this field.

Original language	English
Journal	Critical Care Medicine
Volume	44
Issue number	3
Pages (from-to)	468-477
Number of pages	10
ISSN	0090-3493
DOIs	https://doi.org/10.1097/CCM.0000000000001410
Publication status	Published - 1 Mar 2016

Keywords

Adult
Aged
Cohort Studies
Databases, Factual
Denmark
Erythrocyte Transfusion
Female
Hemorrhage
Humans
Incidence
Intraoperative Complications
Kaplan-Meier Estimate
Male
Middle Aged
Retrospective Studies
Sweden
Journal Article
Research Support, Non-U.S. Gov't

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10.1097/CCM.0000000000001410

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title = "Epidemiology of Massive Transfusion: A Binational Study From Sweden and Denmark",

abstract = "There is an increasing focus on massive transfusion, but there is a paucity of comprehensive descriptions of the massively transfused patients and their outcomes. The objective of this study is to describe the incidence rate of massive transfusion, patient characteristics, and the mortality of massively transfused patients. Design: Descriptive cohort study. Setting: Nationwide study with data from Sweden and Denmark. Patients: The study was based on the Scandinavian Donations and Transfusions database, including all patients receiving 10 or more red cell concentrate transfusions in Sweden from 1987 and in Denmark from 1996. A total of 92,057 patients were included. Patients were followed until the end of 2012. Measurements and Main Results: Descriptive statistics were used to characterize the patients and indications. Post transfusion mortality was expressed as crude 30-day mortality and as long-term mortality using the Kaplan-Meier method and using standardized mortality ratios. The incidence of massive transfusion was higher in Denmark (4.5 per 10,000) than in Sweden (2.5 per 10,000). The most common indication for massive transfusion was major surgery (61.2%) followed by trauma (15.4%). Massive transfusion due to obstetrical bleeding constituted only 1.8%. The overall 5-year mortality was very high (54.6%), however with large differences between indication groups, ranging from 91.1% among those transfused for a malignant disease without surgery to 1.7% among patients transfused for obstetrical bleeding. The early standardized mortality ratios were high and decreased thereafter, but remained elevated throughout the time period. Conclusions: This large-scale study based on nationwide data from Sweden and Denmark describes the complete range of massive transfusion. We report a nonnegligible incidence and both a high absolute mortality and high standardized mortality ratio. The general pattern was similar for Sweden and Denmark, and we believe that similar patterns may be found in other high-resource countries. The study provides a relevant background for clinicians and researchers for designing future studies in this field.",

keywords = "Adult, Aged, Cohort Studies, Databases, Factual, Denmark, Erythrocyte Transfusion, Female, Hemorrhage, Humans, Incidence, Intraoperative Complications, Kaplan-Meier Estimate, Male, Middle Aged, Retrospective Studies, Sweden, Journal Article, Research Support, Non-U.S. Gov't",

author = "M{\"a}rit Halmin and Flaminia Chiesa and Vasan, {Senthil K} and Agneta Wikman and Rut Norda and Klaus Rostgaard and Pedersen, {Ole Birger Vesterager} and Christian Erikstrup and Nielsen, {Kaspar Rene} and Kjell Titlestad and Henrik Ullum and Henrik Hjalgrim and Gustaf Edgren",

year = "2016",

month = mar,

day = "1",

doi = "10.1097/CCM.0000000000001410",

language = "English",

volume = "44",

pages = "468--477",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "Lippincott Williams & Wilkins",

number = "3",

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TY - JOUR

T1 - Epidemiology of Massive Transfusion

T2 - A Binational Study From Sweden and Denmark

AU - Halmin, Märit

AU - Chiesa, Flaminia

AU - Vasan, Senthil K

AU - Wikman, Agneta

AU - Norda, Rut

AU - Rostgaard, Klaus

AU - Pedersen, Ole Birger Vesterager

AU - Erikstrup, Christian

AU - Nielsen, Kaspar Rene

AU - Titlestad, Kjell

AU - Ullum, Henrik

AU - Hjalgrim, Henrik

AU - Edgren, Gustaf

PY - 2016/3/1

Y1 - 2016/3/1

N2 - There is an increasing focus on massive transfusion, but there is a paucity of comprehensive descriptions of the massively transfused patients and their outcomes. The objective of this study is to describe the incidence rate of massive transfusion, patient characteristics, and the mortality of massively transfused patients. Design: Descriptive cohort study. Setting: Nationwide study with data from Sweden and Denmark. Patients: The study was based on the Scandinavian Donations and Transfusions database, including all patients receiving 10 or more red cell concentrate transfusions in Sweden from 1987 and in Denmark from 1996. A total of 92,057 patients were included. Patients were followed until the end of 2012. Measurements and Main Results: Descriptive statistics were used to characterize the patients and indications. Post transfusion mortality was expressed as crude 30-day mortality and as long-term mortality using the Kaplan-Meier method and using standardized mortality ratios. The incidence of massive transfusion was higher in Denmark (4.5 per 10,000) than in Sweden (2.5 per 10,000). The most common indication for massive transfusion was major surgery (61.2%) followed by trauma (15.4%). Massive transfusion due to obstetrical bleeding constituted only 1.8%. The overall 5-year mortality was very high (54.6%), however with large differences between indication groups, ranging from 91.1% among those transfused for a malignant disease without surgery to 1.7% among patients transfused for obstetrical bleeding. The early standardized mortality ratios were high and decreased thereafter, but remained elevated throughout the time period. Conclusions: This large-scale study based on nationwide data from Sweden and Denmark describes the complete range of massive transfusion. We report a nonnegligible incidence and both a high absolute mortality and high standardized mortality ratio. The general pattern was similar for Sweden and Denmark, and we believe that similar patterns may be found in other high-resource countries. The study provides a relevant background for clinicians and researchers for designing future studies in this field.

AB - There is an increasing focus on massive transfusion, but there is a paucity of comprehensive descriptions of the massively transfused patients and their outcomes. The objective of this study is to describe the incidence rate of massive transfusion, patient characteristics, and the mortality of massively transfused patients. Design: Descriptive cohort study. Setting: Nationwide study with data from Sweden and Denmark. Patients: The study was based on the Scandinavian Donations and Transfusions database, including all patients receiving 10 or more red cell concentrate transfusions in Sweden from 1987 and in Denmark from 1996. A total of 92,057 patients were included. Patients were followed until the end of 2012. Measurements and Main Results: Descriptive statistics were used to characterize the patients and indications. Post transfusion mortality was expressed as crude 30-day mortality and as long-term mortality using the Kaplan-Meier method and using standardized mortality ratios. The incidence of massive transfusion was higher in Denmark (4.5 per 10,000) than in Sweden (2.5 per 10,000). The most common indication for massive transfusion was major surgery (61.2%) followed by trauma (15.4%). Massive transfusion due to obstetrical bleeding constituted only 1.8%. The overall 5-year mortality was very high (54.6%), however with large differences between indication groups, ranging from 91.1% among those transfused for a malignant disease without surgery to 1.7% among patients transfused for obstetrical bleeding. The early standardized mortality ratios were high and decreased thereafter, but remained elevated throughout the time period. Conclusions: This large-scale study based on nationwide data from Sweden and Denmark describes the complete range of massive transfusion. We report a nonnegligible incidence and both a high absolute mortality and high standardized mortality ratio. The general pattern was similar for Sweden and Denmark, and we believe that similar patterns may be found in other high-resource countries. The study provides a relevant background for clinicians and researchers for designing future studies in this field.

KW - Adult

KW - Aged

KW - Cohort Studies

KW - Databases, Factual

KW - Denmark

KW - Erythrocyte Transfusion

KW - Female

KW - Hemorrhage

KW - Humans

KW - Incidence

KW - Intraoperative Complications

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Sweden

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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DO - 10.1097/CCM.0000000000001410

M3 - Journal article

C2 - 26901542

SN - 0090-3493

VL - 44

SP - 468

EP - 477

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 3

ER -

Epidemiology of Massive Transfusion: A Binational Study From Sweden and Denmark

Abstract

Keywords

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