Abstract
IntroductionStudies in intensive care unit (ICU) patients have suggested that anemia and blood transfusions can influence outcomes, but these effects have not been widely investigated specifically in surgical ICU patients.MethodsWe retrospectively analyzed the prospectively collected data from all adult patients (>18 years old) admitted to a 50-bed surgical ICU between 1st March 2004 and 30th July 2006.ResultsOf the 5925 patients admitted during the study period, 1833 (30.9%) received a blood transfusion in the ICU. Hemoglobin concentrations were < 9 g/dl on at least one occasion in 57.6% of patients. Lower hemoglobin concentrations were associated with a higher Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score, greater mortality rates, and longer ICU and hospital lengths of stay. Transfused patients had higher ICU (12.5 vs. 3.2%) and hospital (18.3 vs. 6.5%) mortality rates (both p < 0.001) than non-transfused patients. However, ICU and in-hospital mortality rates were similar among transfused and non-transfused matched pairs according to a propensity score (n = 1184 pairs), and after adjustment for possible confounders in a multivariable analysis, higher hemoglobin concentrations (RR 0.97[0.95-0.98], per 1 g/dl, p < 0.001) and blood transfusions (RR 0.96[0.92-0.99], p = 0.031) were independently associated with a lower risk of in-hospital death, especially in patients aged from 66 to 80 years, in patients admitted to the ICU after non-cardiovascular surgery, in patients with higher severity scores, and in patients with severe sepsis.ConclusionsIn this group of surgical ICU patients, anemia was common and was associated with higher morbidity and mortality. Higher hemoglobin concentrations and receipt of a blood transfusion were independently associated with a lower risk of in-hospital death. Randomized control studies are warranted to confirm the potential benefit of blood transfusions in these subpopulations.
Highlights
Studies in intensive care unit (ICU) patients have suggested that anemia and blood transfusions can influence outcomes, but these effects have not been widely investigated in surgical ICU patients
Blood transfusion was associated with a lower risk of in-hospital death in patients aged from 66 to 80 years, in patients admitted to the ICU after non-cardiovascular surgery, in patients with simplified acute physiology score (SAPS) II score greater than 50 and sequential organ failure assessment (SOFA) score more than four on admission to the ICU, and in patients with severe sepsis
Higher hemoglobin concentrations and blood transfusions were independently associated with a lower risk of in-hospital death, especially in patients aged from 66 to 80 years, in patients admitted to the ICU after non-cardiovascular surgery, in patients with higher severity scores, and in patients with severe sepsis
Summary
Studies in intensive care unit (ICU) patients have suggested that anemia and blood transfusions can influence outcomes, but these effects have not been widely investigated in surgical ICU patients. Large observational European [1] and North American [3] cohort studies on blood transfusion practices in critically ill patients reported that blood transfusion was independently associated with an increased risk of death. A landmark study by Hébert and colleagues [9], the transfusion requirements in critically ill patients (TRICC) study, demonstrated that a restrictive strategy of red blood cell (RBC) transfusion was as effective as a liberal strategy These authors [9] reported a survival benefit with the restrictive strategy in patients younger than 55 years and those with acute physiology and chronic health evaluation (APACHE) II scores of 20 or less. In a recent study in pediatric critically ill patients, Lacroix and colleagues [10] reported that restricting transfusions to patients with a hemoglobin threshold of 7 g/dl was not associated with an increase in adverse events compared with patients transfused according to a trigger of 9.5 g/dl
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
