Journal article
Worldwide audit of blood transfusion practice in critically ill patients.
- Vincent JL Department of Intensive Care, Erasme University Hospital, Unversité Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. jlvincent@intensive.org.
- Jaschinski U Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Augsburg, Augsburg, Germany.
- Wittebole X Critical Care Department, Cliniques universitaires St Luc, UCL, Brussels, Belgium.
- Lefrant JY Service des Réanimations, Division Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France.
- Jakob SM Department of Intensive Care Medicine, University Hospital Bern, University of Bern, Bern, Switzerland.
- Almekhlafi GA ICS Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
- Pellis T Anesthesia and Intensive Care, Santa Maria degli Angeli Hospital, Pordenone, Italy.
- Tripathy S Department of Anesthesia, AIIMS, Sijua, Patrapada, Bhubaneswar, Odisha, India.
- Rubatto Birri PN Department of Anesthesiology and Intensive Care, Universitätsklinikum Jena, Jena, Germany.
- Sakr Y Department of Anesthesiology and Intensive Care, Universitätsklinikum Jena, Jena, Germany.
- 2018-04-21
Published in:
- Critical care (London, England). - 2018
Red blood cell
Severity of illness
Worldwide
Adult
Aged
Analysis of Variance
Blood Transfusion
Female
Global Health
Hemoglobins
Hospitalization
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Organ Dysfunction Scores
Proportional Hazards Models
Quality of Health Care
Simplified Acute Physiology Score
English
BACKGROUND
The 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.
METHODS
This 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.
RESULTS
ICU 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.
CONCLUSIONS
More 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.
The 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.
METHODS
This 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.
RESULTS
ICU 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.
CONCLUSIONS
More 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.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s13054-018-2018-9
- PMID 29673409
- Persistent URL
- https://sonar.ch/global/documents/185161
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