Claire Dupuis1,2, Maité Garrouste-Orgeas3, Sébastien Bailly1, Christophe Adrie4, Dany Goldgran-Toledano5, Elie Azoulay6, Stéphane Ruckly1, Guillaume Marcotte7, Bertrand Souweine8, Michael Darmon9, Yves Cohen10, Carole Schwebel11, Guillaume Lacave12, Lila Bouadma1,2, Jean-Francois Timsit1,2. 1. UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care Inserm/ Univ Paris Diderot, Sorbonne Paris Cité, Paris, France. 2. Medical and Infectious Intensive Care Unit, Bichat Claude Bernard University Hospital, AP-HP, Paris, France. 3. Medical-Surgical Intensive Care Unit, Saint-Joseph Hospital, Paris, France. 4. Medical-Surgical Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France. 5. Medical-Surgical Intensive Care Unit, Gonesse Hospital, Gonesse, France. 6. Medical Intensive Care Unit, Saint-Louis University Hospital, APHP, Paris, France. 7. Intensive care Unit, Edouard Herriot University Hospital, Lyon, France. 8. Medical Intensive Care Unit, Clermont-Ferrand University Hospital, Clemont-Ferrand, France. 9. Medical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Priest-en-Jarez, France. 10. Medical-Surgical Intensive Care Unit, Avicenne University Hospital, APHP, Bobigny, France. 11. Medical-Surgical Intensive Care Unit, Grenoble University Hospital, Grenoble Cedex, France. 12. Medical-Surgical Intensive Care Unit, André Mignot Hospital, Le Chesnay, France.
Abstract
OBJECTIVES: RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded. Cohort studies led to conflicting results and did not handle time-dependent covariates and history of treatment. Additional data are thus warranted to guide patient's management. DESIGN: To estimate the effect of one or more RBC within 1 day on three major outcomes (mortality, ICU-acquired infections, and severe hypoxemia) at day 30, we used marginal structural models. A trajectory modeling, based on hematocrit evolution pattern, allowed identification of subgroups. Secondary analyses were performed into each of them. SETTING: A prospective French multicenter database. PATIENTS: Patients with sepsis at admission. Patients with hemorrhagic shock at admission were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, in our cohort of 6,016 patients, RBC transfusion was not associated with death (hazard ratio, 1.07; 95% CI, 0.88-1.30; p = 0.52). However, RBC transfusion was associated with increased occurrence of ICU-acquired infections (hazard ratio, 2.77; 95% CI, 2.33-3.28; p < 0.01) and of severe hypoxemia (hazard ratio, 1.29; 95% CI, 1.14-1.47; p < 0.01). A protective effect from death by the transfusion was found in the subgroup with the lowest hematocrit level (26 [interquartile range, 24-28]) (hazard ratio, 0.72; 95% CI, 0.55-0.95; p = 0.02). CONCLUSIONS: RBC transfusion did not affect overall mortality in critically ill patients with sepsis. Increased occurrence rate of ICU-acquired infection and severe hypoxemia are expected outcomes from RBC transfusion that need to be weighted with its benefits in selected patients.
OBJECTIVES: RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded. Cohort studies led to conflicting results and did not handle time-dependent covariates and history of treatment. Additional data are thus warranted to guide patient's management. DESIGN: To estimate the effect of one or more RBC within 1 day on three major outcomes (mortality, ICU-acquired infections, and severe hypoxemia) at day 30, we used marginal structural models. A trajectory modeling, based on hematocrit evolution pattern, allowed identification of subgroups. Secondary analyses were performed into each of them. SETTING: A prospective French multicenter database. PATIENTS: Patients with sepsis at admission. Patients with hemorrhagic shock at admission were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, in our cohort of 6,016 patients, RBC transfusion was not associated with death (hazard ratio, 1.07; 95% CI, 0.88-1.30; p = 0.52). However, RBC transfusion was associated with increased occurrence of ICU-acquired infections (hazard ratio, 2.77; 95% CI, 2.33-3.28; p < 0.01) and of severe hypoxemia (hazard ratio, 1.29; 95% CI, 1.14-1.47; p < 0.01). A protective effect from death by the transfusion was found in the subgroup with the lowest hematocrit level (26 [interquartile range, 24-28]) (hazard ratio, 0.72; 95% CI, 0.55-0.95; p = 0.02). CONCLUSIONS: RBC transfusion did not affect overall mortality in critically illpatients with sepsis. Increased occurrence rate of ICU-acquired infection and severe hypoxemia are expected outcomes from RBC transfusion that need to be weighted with its benefits in selected patients.
Authors: Raúl Juárez-Vela; Eva María Andrés-Esteban; Ivan Santolalla-Arnedo; Regina Ruiz de Viñaspre-Hernández; Carmen Benito-Puncel; Ainhoa Serrano-Lázaro; Pilar Marcos-Neira; Alba López-Fernández; Clara Isabel Tejada-Garrido; Juan Luis Sánchez-González; Manuel Quintana-Díaz; José Antonio García-Erce Journal: J Clin Med Date: 2022-06-20 Impact factor: 4.964
Authors: Anna Brandtner; Piotr Tymoszuk; Manfred Nairz; Georg F Lehner; Gernot Fritsche; Anja Vales; Andreas Falkner; Harald Schennach; Igor Theurl; Michael Joannidis; Günter Weiss; Christa Pfeifhofer-Obermair Journal: J Intensive Care Date: 2020-10-01