Impact of restrictive versus liberal transfusion and clinical outcomes in critically ill children: A retrospective observational study

Abstract

Background and AimsCritically ill children with anemia often requires blood transfusion, which can cause several complications. It is important to decide when to start the red blood cell (RBC) transfusion; however, the guidelines is still lacking. The aim of this study was to compare restrictive and liberal transfusion strategy.MethodsThis is an observational retrospective study of critically‐ill children who receive RBC transfusion. Subjects categorized into two groups by initial hemoglobin (Hb), that is, restrictive (Hb ≤ 7 g/dl) and liberal (Hb ≤ 9.5 g/dl) strategy. In each group, subjects categorized based on: (1) Hb increment: high (increased ≥2.5 g/dl) and low (increase <2.5 g/dl) and (2) final Hb level: low (<7.0 mg/dl), moderate (7.0–10.0 mg/dl), and high (>10.0 mg/dl). Patient with hematologic or congenital disorder, severe malnutrition, chronic infection‐related anemia, and transfusion in Hb level ≥9.5 g/dl were exclude. Each patients were evaluated for the clinical outcome, which is: intensive care length of stay (IC‐LOS), length of mechanical ventilation (LoMV), and mortality rate.ResultsClinical outcome and mortality rates of both transfusion strategies are similar. The mortality rates were lower in higher Hb increment and final Hb level (p = 0.04 and p = 0.01, respectively). Multivariate analysis in all groups revealed mortality rate had moderate correlation with Hb increment (odds ratio [OR] = 0.694, 95% confidence interval [CI] 0.549–0.878; p = 0.002) and moderate correlation (OR = 0.642, 95% CI 0.519–0.795; p = 0.000) with final Hb level. The similar results was found after categorization based on transfusion strategy.ConclusionWe conclude the restrictive and liberal transfusion strategy have a similar effect to IC‐LOS, LoMV, and mortality rate. High Hb increment (≥2.5 g/dl) and moderate‐high final Hb (≥7.0 g/dl) after transfusion reduce the mortality rate.