Correlation between red blood cell transfusion volume and mortality in patients with massive blood transfusion: A large multicenter retrospective study.

Jiang-Cun Yang,Yang Sun,Cui-Xiang Xu,Yong-Gang Xu,Ling Li,Yao-Jun Song,Qian-Li Dang,Hong Yan

doi:10.3892/etm.2014.2068

Abstract

This study aimed to explore the correlation between red blood cell (RBC) transfusion volume and patient mortality in massive blood transfusion. A multicenter retrospective study was carried out on 1,601 surgical inpatients who received massive blood transfusion in 20 large comprehensive hospitals in China. According to RBC transfusion volume and duration, the patients were divided into groups as follows: 0–4, 5–9, 10–14, 15–19, 20–24, 25–29, 30–39 and ≥40 units within 24 or 72 h. Mortality in patients with different RBC transfusion volumes was analyzed. It was found that patient mortality increased with the increase in the volume of RBC transfusion when the total RBC transfusion volume was ≥10 units within 24 or 72 h. Survival analysis revealed significant differences in mortality according to the RBC transfusion volume (χ2=72.857, P<0.001). Logistic regression analysis revealed that RBC transfusion volume is an independent risk factor [odds ratio (OR) = 0.52; confidence interval (CI): 0.43–0.64; P<0.01] for the mortality of patients undergoing a massive blood transfusion. When RBCs were transfused at a volume of 5–9 units within 24 and 72 h, the mortality rate was the lowest, at 3.7 and 2.3% respectively. It is concluded that during massive blood transfusion in surgical inpatients, there is a correlation between RBC transfusion volume within 24 or 72 h and the mortality of the patients. Patient mortality increases with the increase in the volume of RBC transfusion. RBC transfusion volume, the length of stay at hospital and intensive care unit stay constitute the independent risk factors for patient mortality.

Highlights

Massive blood transfusion is commonly defined as the administration of ≥10 units of packed red blood cells to an individual patient [1,2] or the transfusion of more than one blood volume in 24 h [1,3,4,5]
Studies have found that mortality remains high for trauma patients who have received massive blood transfusion and suggest that there is a certain correlation between red blood cell (RBC) transfusion volume and the mortality of patients [6,7,8]
One unit of packed red blood cells (pRBCs) was derived from 200 ml whole blood and had a volume of 140‐172 ml

Summary

Introduction

Massive blood transfusion is commonly defined as the administration of ≥10 units of packed red blood cells (pRBCs) to an individual patient [1,2] or the transfusion of more than one blood volume in 24 h [1,3,4,5]. Massive blood transfusion is often provided to those who are injured during military operations, who have multiple injuries due to other causes, and who undergo complex surgery. Transfusion plays a key role in saving the lives of patients who have suffered massive blood loss. Studies have found that mortality remains high for trauma patients who have received massive blood transfusion and suggest that there is a certain correlation between RBC transfusion volume and the mortality of patients [6,7,8]. Stanworth et al [9] found that the mortality of patients who had received a pRBC transfusion was 9% for 0‐5 units, 22% for 6‐9 units and 42% for ≥10 units. It is necessary to maintain a balance between the advantages and disadvantages of RBC transfusion during massive blood transfusion

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