The effect of age and clinical circumstances on the outcome of red blood cell transfusion in critically ill patientsReport as inadecuate




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Critical Care

, 18:487

First Online: 30 August 2014Received: 16 December 2013Accepted: 01 August 2014

Abstract

IntroductionWhether red blood cell RBC transfusion is beneficial remains controversial. In both retrospective and prospective evaluations, transfusion has been associated with adverse, neutral, or protective effects. These varying results likely stem from a complex interplay between transfusion, patient characteristics, and clinical context. The objective was to test whether age, comorbidities, and clinical context modulate the effect of transfusion on survival.

MethodsBy using the multiparameter intelligent monitoring in intensive care II database v. 2.6, a retrospective analysis of 9,809 critically ill patients, we evaluated the effect of RBC transfusion on 30-day and 1-year mortality. Propensity score modeling and logistic regression adjusted for known confounding and assessed the independent effect of transfusion on 30-day and 1-year mortality. Sensitivity analysis was performed by using 3,164 transfused and non-transfused pairs, matched according the previously validated propensity model for RBC transfusion.

ResultsRBC transfusion did not affect 30-day or 1-year mortality in the overall cohort. Patients younger than 55 years had increased odds of mortality OR, 1.71; P < 0.01 with transfusion. Patients older than 75 years had lower odds of 30-day and 1-year mortality OR, 0.70; P < 0.01 with transfusion. Transfusion was associated with worse outcome among patients undergoing cardiac surgery OR, 2.1; P < 0.01. The propensity-matched population corroborated findings identified by regression adjustment.

ConclusionA complex relation exists between RBC transfusion and clinical outcome. Our results show that transfusion is associated with improved outcomes in some cohorts and worse outcome in others, depending on comorbidities and patient characteristics. As such, future investigations and clinical decisions evaluating the value of transfusion should account for variations in baseline characteristics and clinical context.

AbbreviationsABC trialAnemia and Blood Transfusion in Critical Care trial

APACHEII scoreAcute Physiology And Chronic Health Evaluation II

BIDMCBeth Israel Deaconess Medical Center

CCUcardiac critical care unit

CIconfidence interval

CSRUcardiac surgery critical care unit

GIgastrointestinal

GIBgastrointestinal bleed

HCThematocrit

ICD-9International Classification of Diseases, revision 9

ICUintensive care unit

MImyocardial infarction

MICUmedical intensive care unit

MIMICII databaseMultiparameter Intelligent Monitoring in Intensive Care II database

ORodds ratio

RBCred blood cell

SAPSSimplified Acute Physiology Score

SICUsurgical intensive care unit

SOAP trialSepsis Occurrence in Acutely Ill Patients trial

SOFASequential Organ Failure Assessment score

STEMIST-elevation myocardial infarction

TRACS trialTransfusion Requirement After Cardiac Surgery trial

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0487-z contains supplementary material, which is available to authorized users.

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Author: Andre Dejam - Brian E Malley - Mengling Feng - Federico Cismondi - Shinhyuk Park - Saira Samani - Zahra Aziz Samani - Dua

Source: https://link.springer.com/







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