Abstract
There is paucity of data on the transfusion need and its impact on the overall mortality in patients with COVID-19. We explored mortality in hospitalized patients with COVID-19 who required transfusions. Information on clinical variables and in-hospital mortality were obtained from medical records of 422 patients admitted to medical wards or the Intensive Care Unit (ICU). In-hospital mortality occurred in 147 (34.8%) patients, 94 (63.9%) of whom were admitted to the ICU. The median fatalities age was 77 years (IQR 14). Overall, 100 patients (60 males) received transfusion during hospitalization. The overall mortality was significantly and independently associated with age, ICU admission, Chronic Kidney Disease (CKD), and the number of transfused Red Blood Cell (RBC) units. Specifically, CKD was associated with mortality in patients admitted to medical wards, whereas the number of transfused RBC units predicted mortality in those admitted to the ICU. Transfusion strongly interacted with the admission to ICU (OR: 9.9; 95% CI: 2.5–40.0). In patients with COVID-19, age is one of the strongest risk factors in predicting mortality independently of the disease’s severity. CKD confers a higher risk of mortality in patients admitted to medical wards. In those admitted to the ICU, the more RBC units are transfused, the more mortality increases.
Highlights
When we separately analyzed the two groups, we found that Chronic Kidney Disease (CKD) was significantly associated with mortality in patients admitted to medical wards, whereas the number of transfused Red Blood Cell (RBC) units predicted mortality in those admitted to the intensive care unit (ICU)
We explored patients’ need for transfusion in patients with COVID-19 hospitalized in medical wards or the ICU and investigated the potential role of several risk factors in predicting mortality in patients admitted to medical wards or the ICU
This is not surprising, as transfusion requirements progressively increase with the worsening of the clinical condition. Consistent with these findings, patients undergoing non -invasive and invasive ventilation are significantly more transfused than those who do not need ventilation (Table 2). When we corrected these associations for potential confounders, we found that non-invasive, as well as invasive ventilation were not independently associated with mortality; which is likely due to the fact that most patients admitted to the ICU undergo ventilation (Table 1)
Summary
The SARS-CoV-2 disease outbreak has caused a dramatic rise in mortality worldwide. The pandemic has had a significant impact on blood supplies through a reduction in blood donation [1,2]. In this context, it appears of relevance to understand the real need of transfusion in patients with COVID-19—the respiratory disease consequent to the infection—and its potential impact on clinical outcomes, first of all mortality. COVID-19 can present with a variety of clinical manifestations (from nil, to pauci-symptomatic, to dramatic disease), leading to mortality especially those subjects with one or more comorbidities [3]. The mortality rate is high in patients admitted to the intensive care unit (ICU) [4,5], with older patients showing a higher fatality rate [5]
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