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Critical Care

, 14:R92

First Online: 24 May 2010Received: 26 December 2009Revised: 14 March 2010Accepted: 24 May 2010

Abstract

IntroductionStudies in intensive care unit ICU patients have suggested that anemia and blood transfusions can influence outcomes, but these effects have not been widely investigated specifically in surgical ICU patients.

MethodsWe retrospectively analyzed the prospectively collected data from all adult patients >18 years old admitted to a 50-bed surgical ICU between 1 March 2004 and 30 July 2006.

ResultsOf the 5925 patients admitted during the study period, 1833 30.9% received a blood transfusion in the ICU. Hemoglobin concentrations were < 9 g-dl on at least one occasion in 57.6% of patients. Lower hemoglobin concentrations were associated with a higher Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score, greater mortality rates, and longer ICU and hospital lengths of stay. Transfused patients had higher ICU 12.5 vs. 3.2% and hospital 18.3 vs. 6.5% mortality rates both p < 0.001 than non-transfused patients. However, ICU and in-hospital mortality rates were similar among transfused and non-transfused matched pairs according to a propensity score n = 1184 pairs, and after adjustment for possible confounders in a multivariable analysis, higher hemoglobin concentrations RR 0.970.95-0.98, per 1 g-dl, p < 0.001 and blood transfusions RR 0.960.92-0.99, p = 0.031 were independently associated with a lower risk of in-hospital death, especially in patients aged from 66 to 80 years, in patients admitted to the ICU after non-cardiovascular surgery, in patients with higher severity scores, and in patients with severe sepsis.

ConclusionsIn this group of surgical ICU patients, anemia was common and was associated with higher morbidity and mortality. Higher hemoglobin concentrations and receipt of a blood transfusion were independently associated with a lower risk of in-hospital death. Randomized control studies are warranted to confirm the potential benefit of blood transfusions in these subpopulations.

AbbreviationsAPACHEacute physiology and chronic health evaluation

IQRinterquartile

RBCred blood cell

RRrelative risk

SAPSsimplified acute physiology score

SOAPsepsis occurrence in acutely ill patients

SOFAsequential organ failure assessment

TRICCtransfusion requirements in critically ill patients

TRIMtransfusion-related immunosuppression

CICompeting interests

Electronic supplementary materialThe online version of this article doi:10.1186-cc9026 contains supplementary material, which is available to authorized users.

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Author: Yasser Sakr - Suzana Lobo - Stefanie Knuepfer - Elizabeth Esser - Michael Bauer - Utz Settmacher - Dagmar Barz - Konrad Re

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



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