Edwige Péju1,2,3,4,5,6,7,8,9, Jean-François Llitjos1,2,3,4,5,6,7,8,9, Julien Charpentier1, Anne François4, Nathalie Marin1, Alain Cariou1,2, Jean-Daniel Chiche1,2,3,4,5,6,7,8,9, Jean-Paul Mira1,2,3,4,5,6,7,8,9, Jérôme Lambert2,5,6, Matthieu Jamme1,2,3,4,5,6,7,8,9, Frédéric Pène1,2,3,4,5,6,7,8,9. 1. Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris AP-HP.Centre, Paris, France. 2. Université de Paris, Paris, France. 3. INSERM U1016, CNRS UMR 8104, Institut Cochin, Paris, France. 4. Etablissement Français du Sang, Paris, France. 5. Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany. 6. INSERM U1153, ECSTRRA Team, Paris, France. 7. Réanimation médico-chirurgicale, hôpital Poissy Saint-Germain, Poissy, France. 8. INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), Université Versailles Saint-Quentin, Villejuif, France. 9. Centre de recherche en Epidémiologie et Santé des Populations, INSERM U1018, Université Paris-Sud, Villejuif, France.
Abstract
OBJECTIVES: Transfusions of blood products are common in critically ill patients and have a potential for immunomodulation. The aim of this study is to address the impact of transfusion of blood products on the susceptibility to ICU-acquired infections in the high-risk patients with septic shock. DESIGN: A single-center retrospective study over a 10-year period (2008-2017). SETTING: A medical ICU of a tertiary-care center. PATIENTS: All consecutive patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients who were discharged or died within the first 48 hours were excluded. INTERVENTIONS: RBC, platelet, and fresh frozen plasma transfusions collected up to 24 hours prior to the onset of ICU-acquired infection. MEASUREMENTS AND MAIN RESULTS: During the study period, 1,152 patients were admitted for septic shock, with 893 patients remaining alive in the ICU after 48 hours of management. A first episode of ICU-acquired infection occurred in 28.3% of the 48-hour survivors, with a predominance of pulmonary infections (57%). Patients with ICU-acquired infections were more likely to have received RBC, platelet, and fresh frozen plasma transfusions. In a multivariate Cox cause-specific analysis, transfusions of platelets (cause-specific hazard ratio = 1.55 [1.09-2.20]; p = 0.01) and fresh frozen plasma (cause-specific hazard ratio = 1.38 [0.98-1.92]; p = 0.05) were independently associated with the further occurrence of ICU-acquired infections. CONCLUSIONS: Transfusions of platelets and fresh frozen plasma account for risk factors of ICU-acquired infections in patients recovering from septic shock. The occurrence of ICU-acquired infections should be considered as a relevant endpoint in future studies addressing the indications of transfusions in critically ill patients.
OBJECTIVES: Transfusions of blood products are common in critically ill patients and have a potential for immunomodulation. The aim of this study is to address the impact of transfusion of blood products on the susceptibility to ICU-acquired infections in the high-risk patients with septic shock. DESIGN: A single-center retrospective study over a 10-year period (2008-2017). SETTING: A medical ICU of a tertiary-care center. PATIENTS: All consecutive patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients who were discharged or died within the first 48 hours were excluded. INTERVENTIONS: RBC, platelet, and fresh frozen plasma transfusions collected up to 24 hours prior to the onset of ICU-acquired infection. MEASUREMENTS AND MAIN RESULTS: During the study period, 1,152 patients were admitted for septic shock, with 893 patients remaining alive in the ICU after 48 hours of management. A first episode of ICU-acquired infection occurred in 28.3% of the 48-hour survivors, with a predominance of pulmonary infections (57%). Patients with ICU-acquired infections were more likely to have received RBC, platelet, and fresh frozen plasma transfusions. In a multivariate Cox cause-specific analysis, transfusions of platelets (cause-specific hazard ratio = 1.55 [1.09-2.20]; p = 0.01) and fresh frozen plasma (cause-specific hazard ratio = 1.38 [0.98-1.92]; p = 0.05) were independently associated with the further occurrence of ICU-acquired infections. CONCLUSIONS: Transfusions of platelets and fresh frozen plasma account for risk factors of ICU-acquired infections in patients recovering from septic shock. The occurrence of ICU-acquired infections should be considered as a relevant endpoint in future studies addressing the indications of transfusions in critically ill patients.
Authors: Maximilian Dietrich; Tobias Hölle; Lazar Detelinov Lalev; Martin Loos; Felix Carl Fabian Schmitt; Mascha Onida Fiedler; Thilo Hackert; Daniel Christoph Richter; Markus Alexander Weigand; Dania Fischer Journal: J Clin Med Date: 2022-07-27 Impact factor: 4.964
Authors: Carl Thomas Anthon; Frédéric Pène; Anders Perner; Elie Azoulay; Kathryn Puxty; Andry Van De Louw; Andreas Barratt-Due; Sanjay Chawla; Pedro Castro; Pedro Povoa; Luis Coelho; Victoria Metaxa; Laveena Munshi; Matthias Kochanek; Tobias Liebregts; Thomas Kander; Johanna Hästbacka; Morten Hylander Møller; Lene Russell Journal: Acta Anaesthesiol Scand Date: 2022-08-23 Impact factor: 2.274