Worldwide audit of blood transfusion practice in critically ill patients

Abstract

BackgroundThe aim was to describe transfusion practice in critically ill patients at an international level and evaluate the effects of red blood cell (RBC) transfusion on outcomes in these patients.MethodsThis was a pre-planned sub-study of the Intensive Care Over Nations audit, which involved 730 ICUs in 84 countries and included all adult patients admitted between 8 May and 18 May 2012, except admissions for routine postoperative surveillance.ResultsICU and hospital outcomes were recorded. Among the 10,069 patients included in the audit, data related to transfusion had been completed for 9553 (mean age 60 ± 18 years, 60% male); 2511 (26.3%) of these had received a transfusion, with considerable variation among geographic regions. The mean lowest hemoglobin on the day of transfusion was 8.3 ± 1.7 g/dL, but varied from 7.8 ± 1.4 g/dL in the Middle East to 8.9 ± 1.9 g/dL in Eastern Europe. Hospital mortality rates were higher in transfused than in non-transfused patients (30.0% vs. 19.6%, p < 0.001) and increased with increasing numbers of transfused units. In an extended Cox proportional hazard analysis, the relative risk of in-hospital death was slightly lower after transfusion in the whole cohort (hazard ratio 0.98, confidence interval 0.96–1.00, p = 0.048). There was a stepwise decrease in the hazard ratio for mortality after transfusion with increasing admission severity scores.ConclusionsMore than one fourth of critically ill patients are transfused during their ICU stay, with considerable variations in transfusion practice among geographic regions. After adjustment for confounders, RBC transfusions were associated with a slightly lower relative risk of in-hospital death, especially in the most severely ill patients, highlighting the importance of taking the severity of illness into account when making transfusion decisions.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2018-9) contains supplementary material, which is available to authorized users.

Blood Transfusion Practice in Critically Ill Patients and Clinical Outcomes

“…As shown in other studies, the rate of transfusion was found to be related to the prolonged length of ICU stay (21). In the study conducted by Vincent et al (10) and in another multicenter study of 1136 patients, disease severity scores such as SAPS II, APACHE (Acute Physiology and Chronic Health Evaluation) II, and SOFA (Sequential Organ Failure Assessment) were reported to be higher in transfused patients (5).In our study, the SAPS II score and ICU mortality were found to be higher in patients who had received transfusion (p<0.001). Furthermore, patients needed more life-support treatments such as mechanical ventilation and vasopressor support during ICU stay.…”

“…The rate of transfusion in our intensive care unit was lower compared to these studies. In the studies, the rate of the patients who had received transfusion on the first day of ICU admission was reported to be 7.1-19.4% (10). In our study, it was determined that 40 (7.1%) patients were received transfusion on the first day of ICU admission.…”

“…In this study, it was determined that the rate of the patients who had received transfusion during the ICU stay was 17.1% and the transfusion threshold was 6.9 g/dL. The transfusion rate was reported to be 37% in the ABC study, 44% in the CRIT study, 33% in the SOAP study, and 15-34.9% in the study conducted by Vincent et al (10) in 2018 and evaluating transfusion practice in countries around the world (5,11,12). Soril LJJ et al (13) reported that more than 40% of patients who were followed up in the surgical and medical ICU with no hemorrhage were transfused with hemoglobin levels between 7 g/dL and 7.9 g/ dL.…”

The effect of red blood cell transfusion on iron metabolism in critically ill patients

“…More than one-fourth of critically ill patients receive at least one RBC transfusion during their ICU stay. 4 A RBC unit contains 220 to 250 mg of iron bound to Hb. 5 Given that up to 25% of the RBCs are cleared shortly after transfusion, 6-8 a RBC transfusion may result in the delivery of an iron load approximating 50 to 60 mg to the monocyte/macrophage system, from where it is released into the plasma.…”

“…Currently, anemia is treated with red blood cell (RBC) transfusions. More than one‐fourth of critically ill patients receive at least one RBC transfusion during their ICU stay . A RBC unit contains 220 to 250 mg of iron bound to Hb .…”