Long-term Survival in the Intensive Care Unit After Erythrocyte Blood Transfusion

Engoren, Milo; Arslanian‐Engoren, Cynthia

doi:10.4037/ajcc2009193

Cited by 23 publications

(29 citation statements)

References 27 publications

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“…Such a practice might be an effective strategy to lower the frequency and amount of blood transfusion [16,17,18,19]. The pretransfusion hemoglobin level in our study is the lowest among the thresholds used in ICU practice since the publication of the TRICC study, and therefore, represents successful implementation of evidence-based transfusion practice into the complex ICU clinical setting [1,2,11,14,20]. It was also noticed that those patients who were transfused following their discharge from the ICU had a pretransfusion hemoglobin level trigger significantly higher than that adopted in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Blood Transfusion Practice in Critically Ill Patients: A Single Institutional Experience

Al-Faris¹,

Al-Fares

Malek

et al. 2012

Med Princ Pract

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Objectives: To assess the transfusion practice in the intensive care unit (ICU) in a general hospital in Kuwait relative to indications, pretransfusion hemoglobin, red blood cell (RBC) use and outcome. Subjects and Methods: 475 patients were admitted to the ICU during the study period (January 2009 to February 2010). Ninety-nine received RBC transfusion. Demographic, clinical and transfusion data were prospectively collected for the 99 patients who were followed up for 30 days, until hospital discharge, or death, whichever occurred first. Indications for RBC transfusion included hemorrhage in 39 patients, improving oxygen-carrying capacity in 55, and hemolysis in 5. Results: Of the 99 transfused patients, 22 (22.22%) were also transfused after discharge from the ICU. Transfusions were more frequent in patients admitted with respiratory failure (30, 30.3%), hemorrhagic shock (24, 24.2%), and septic shock (18, 18.4%). The mean pretransfusion hemoglobin in ICU transfusions was statistically different (70.9 ± 12.7 g/l) from transfusions after discharge (79.7 ± 9.4 g/l) (p < 0.001). Longer ICU stay was associated with more RBC units transfused per transfusion episode per patient (p < 0.001). The Sequential Organ Failure Assessment (SOFA) score was significantly associated with the number of RBC units transfused per patient (p = 0.006). Mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and SOFA scores, the need and duration for mechanical ventilation, and the length of stay in hospital. Conclusion: Intensivists in our center followed a restrictive transfusion practice, by adopting a low pretransfusion hemoglobin threshold. Decisions on RBC transfusions seemed in most cases to be based on a ‘transfusion trigger’ rather than a physiologic need.

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Section: Discussionmentioning

confidence: 99%

Blood Transfusion Practice in Critically Ill Patients: A Single Institutional Experience

Al-Faris¹,

Al-Fares

Malek

et al. 2012

Med Princ Pract

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“…Blood transfusions after CABG have commonly been associated with increased long-term mortality (1)(2)(3)(4)(5)(6)(7)(8) as has CABG combined with AVR (9). We reached different results in a CABG population, where we extended the number of risk-factors entered in the survival analysis and did not find any association between transfusion of RBC and long-term survival in patients only undergoing CABG (10).…”

Section: Introductionmentioning

confidence: 88%

Risks Associated With the Transfusion of Various Blood Products in Aortic Valve Replacement

Bjursten

Al-Rashidi

Dardashti

et al. 2013

The Annals of Thoracic Surgery

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“…Analyses of subgroups were not reported in three studies [32,42,43]; eleven studies did not provide information on handling of missing data. Six studies reached very high overall quality [2,34,35,37,39,41], nine studies reached high overall quality [4,19,21,33,36,38,40], and the other three studies reached median overall quality [31,32,42], no study reached low overall quality. All risk of bias assessments were conducted by two authors (YZ and CL).…”

Section: Risk Of Bias Assessmentmentioning

confidence: 97%

“…We calculated the crude effect value through count data, and the crude OR (95%CI) was 5.33 (3.17 to 11.56). Table 1 provides detail information of the 18 included studies [2][3][4]19,21,[31][32][33][34][35][36][37][38][39][40][41][42][43].…”

Section: Study Selectionmentioning

confidence: 99%

Association of red blood cell transfusion and in-hospital mortality in patients admitted to intensive care unit: a systematic review and meta-analysis

Zheng¹,

Lü²,

Wei³

et al. 2014

Critical Care

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Introduction: Previous research has debated whether red blood cell (RBC) transfusion is associated with decreased or increased mortality in patients admitted to the intensive care unit (ICU). We conducted a systematic review and meta-analysis to assess the relationship of RBC transfusion with in-hospital mortality in ICU patients. Methods: We carried out a literature search on Medline (1950 through May 2013), Web of Science (1986 through May 2013 and Embase (1980 through May 2013. We included all prospective and retrospective studies on the association between RBC transfusion and in-hospital mortality in ICU patients. The relative risk for the overall pooled effects was estimated by random effects model. Sensitivity analyses were conducted to assess potential bias. Results: The meta-analysis included 28,797 participants from 18 studies. The pooled relative risk for transfused versus nontransfused ICU patients was 1.431 (95% CI, 1.105 to 1.854). In sensitivity analyses, the pooled relative risk was 1.211 (95% CI, 0.975 to 1.505) if excluding studies without adjustment for confounders, 1.178 (95% CI, 0.937 to 1.481) if excluding studies with relative high risk of bias, and 0.901 (95% CI, 0.622 to 1.305) if excluding studies without reporting hazard ratio (HR) or relative risk (RR) as an effect size measure. Subgroup analyses revealed increased risks in studies enrolling patients from all ICU admissions (RR 1.513, 95%CI 1.123 to 2.039), studies without reporting information on leukoreduction (RR 1.851, 95%CI 1.229 to 2.786), studies reporting unadjusted effect estimates (RR 3.933, 95%CI 2.107 to 7.343), and studies using odds ratio as an effect measure (RR 1.465, 95%CI 1.049 to 2.045). Meta-regression analyses showed that RBC transfusion could decrease risk of mortality in older patients (slope coefficient −0.0417, 95%CI −0.0680 to −0.0154). Conclusions: There is lack of strong evidence to support the notion that ICU patients who receive RBC transfusion have an increased risk of in-hospital death. In studies adjusted for confounders, we found that RBC transfusion does not increase the risk of in-hospital mortality in ICU patients. Type of patient, information on leukoreduction, statistical method, mean age of patient enrolled and publication year of the article may account for the disagreement between previous studies.

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Long-term Survival in the Intensive Care Unit After Erythrocyte Blood Transfusion

Cited by 23 publications

References 27 publications

Blood Transfusion Practice in Critically Ill Patients: A Single Institutional Experience

Blood Transfusion Practice in Critically Ill Patients: A Single Institutional Experience

Risks Associated With the Transfusion of Various Blood Products in Aortic Valve Replacement

Association of red blood cell transfusion and in-hospital mortality in patients admitted to intensive care unit: a systematic review and meta-analysis

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