scholarly journals Effects of Red Blood Cell Transfusions on Morbidity and Mortality in Non-Septic Critically Ill Patients; A Propensity Score Matched Study

2020 ◽  
Author(s):  
Thomas Kander ◽  
Caroline Ulfsdotter Nilsson ◽  
Daniel Larsson ◽  
Peter Bentzer
Keyword(s):  
Respiratory Failure ◽  
Propensity Score ◽  
Blood Cell ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Critically Ill Patients ◽  
Hemoglobin Level ◽  
Low Grade ◽  
Matched Study ◽  
Rbc Transfusion

Abstract BackgroundRBC-transfusions can be lifesaving, but are also associated with harm. To further examine any effect of red blood cell (RBC)-transfusions given to critically ill patients that were not exposed to the risks of anemia or sepsis, we designed this retrospective propensity score matched study. The aim was to compare mortality and morbidity in non-septic critically ill patients that were given low-grade RBC-transfusions at hemoglobin level > 70 g/L with patients without RBC-transfusions any of the first 5 days in intensive care.MethodsAdult patients admitted to a general 9-bed intensive care unit between 2007-2018 at a tertiary university hospital, were eligible for inclusion. Patients that received > 2 units RBC-transfusion during the first five days after admission, with pre-transfusion hemoglobin level <70 g/L or with severe sepsis or septic shock were excluded. Outcomes were 28-, 90- and 180-day mortality, highest acute kidney injury network (AKIN) score, days alive and free of organ support the first 28 days and highest sequential organ failure assessment score (SOFA-max).ResultsIn total 9491 admissions were recorded during the study period. Propensity score matching at 1:1 ratio resulted in two well matched group with 682 unique patients in each. Median pre-transfusion hemoglobin was 98 g/L (interquartile range 91-106 g/L). Mortality at the measured time points were higher in the RBC-group with an absolute risk increase for death at 180 days of 4.8% [95% confidence interval 2.5 to 7.2%], (p<0.001). Low grade RBC-transfusion was also associated with renal, circulatory and respiratory failure as well as higher SOFA-max score. ConclusionLow-grade leukoreduced RBC-transfusions given to non-septic critically ill patients without significant anemia, was strongly associated with increased mortality, increased kidney-, circulatory- and respiratory- failure as well as with higher SOFA-max score. These findings further strengthen the evidence supporting a restrictive use of RBC-transfusions in critically ill patients.

scholarly journals Study protocol and pilot results of an observational cohort study evaluating effect of red blood cell transfusion on oxygenation and mitochondrial oxygen tension in critically ill patients with anaemia: the INsufficient Oxygenation in the Intensive Care Unit (INOX ICU-2) study

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036351 ◽  
Author(s):  
Meryem Baysan ◽  
Mendi S Arbous ◽  
Egbert G Mik ◽  
Nicole P Juffermans ◽  
Johanna G van der Bom
Keyword(s):  
Intensive Care ◽  
Blood Cell ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Critically Ill Patients ◽  
Tissue Oxygenation ◽  
Protoporphyrin Ix ◽  
Oxygen Balance ◽  
Mixed Effect ◽  
Rbc Transfusion

IntroductionThe recently developed protoporphyrin IX-triple state lifetime technique measures mitochondrial oxygenation tension (mitoPO2) in vivo at the bedside. MitoPO2might be an early indicator of oxygen disbalance in cells of critically ill patients and therefore may support clinical decisions regarding red blood cell (RBC) transfusion. We aim to investigate the effect of RBC transfusion and the associated changes in haemoglobin concentration on mitoPO2 and other physiological measures of tissue oxygenation and oxygen balance in critically ill patients with anaemia. We present the protocol and pilot results for this study.Methods and analysisWe perform a prospective multicentre observational study in three mixed intensive care units in the Netherlands with critically ill patients with anaemia in whom an RBC transfusion is planned. The skin of the anterior chest wall of the patients is primed with a 5-aminolevulinic acid patch for 4 hours for induction of mitochondrial protoporphyrin-IX to enable measurements of mitoPO2, which is done with the COMET monitoring device. At multiple predefined moments, before and after RBC transfusion, we assess mitoPO2 and other physiological parameters of oxygen balance and tissue oxygenation. Descriptive statistics will be used to describe the data. A linear mixed-effect model will be used to study the association between RBC transfusion and mitoPO2 and other traditional parameters of oxygenation, oxygen delivery and oxygen balance. Missing data will be imputed using multiple imputation methods.Ethics and disseminationThe institutional ethics committee of each participating centre approved the study (reference P16.303), which will be conducted according to the 1964 Helsinki declaration and its later amendments. The results will be submitted for publication in peer-reviewed journals and presented at scientific conferences.Trial registration numberNCT03092297.

Red blood cell transfusion is associated with decreased in-hospital muscle strength among critically ill patients requiring mechanical ventilation

2013 ◽  
Vol 28 (6) ◽  
pp. 1079-1085 ◽  
Author(s):  
Elizabeth C. Parsons ◽  
Erin K. Kross ◽  
Naeem A. Ali ◽  
Lisa K. Vandevusse ◽  
Ellen S. Caldwell ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Muscle Strength ◽  
Blood Cell ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Critically Ill Patients ◽  
Red Blood Cell Transfusion

scholarly journals Author Correction: Ascorbic acid as an adjunctive therapy in critically ill patients with COVID-19: a propensity score matched study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Aljuhani ◽  
Khalid Bin Saleh ◽  
Hisham A. Badreldin ◽  
Abdullah Al Harthi ◽  
...  
Keyword(s):  
Ascorbic Acid ◽  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adjunctive Therapy ◽  
Matched Study

ANEMIA EVALUATION AND OUTCOME IN CRITICALLY ILL PATIENTS SUBMITTED TO A RED BLOOD CELL TRANSFUSION RESTRICTIVE POLICY.

2006 ◽  
Vol 34 ◽  
pp. A74
Author(s):  
Daniele M Torres ◽  
Rafael B Tomita ◽  
Maria Tereza M Ferrari ◽  
João M Silva ◽  
Luciano Sanches ◽  
...  
Keyword(s):  
Blood Cell ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Critically Ill Patients ◽  
Red Blood Cell Transfusion ◽  
Restrictive Policy

scholarly journals The Association between Red Blood Cell Distribution Width and Mortality in Critically Ill Patients with Acute Kidney Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Benji Wang ◽  
Huaya Lu ◽  
Yuqiang Gong ◽  
Binyu Ying ◽  
Bihuan Cheng
Keyword(s):  
Acute Kidney Injury ◽  
Blood Cell ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Cell Distribution ◽  
Distribution Width ◽  
The Impact ◽  
Red Blood Cell Distribution

Background. Several investigators have sought risk factors for mortality in acute kidney injury (AKI). However, no epidemiological studies have investigated the impact of red blood cell distribution width (RDW) on prognosis for critically ill patients with AKI. The aim of this study was to investigate the association of RDW with mortality in these patients. Methods. We analyzed data from the MIMIC-III. RDW was measured upon ICU admission. The association between RDW and mortality of AKI was determined using a multivariate logistic regression and was expressed as the adjusted odds ratio with associated 95% confidence interval (CI). We also conducted subgroup analyses to determine the consistency of this association. Results. A total of 14,078 critically ill patients with AKI were eligible for this analysis. In multivariate analysis, adjusted for age and gender and compared with the reference group (RDW 11.1-13.4%) related to hospital mortality, the adjusted ORs (95% CIs) for RDW levels 13.5-14.3%, 14.4-15.6%, and 15.7-21.2% were 1.22 (1.05, 1.43), 1.56 (1.35, 1.81), and 2.66 (2.31, 3.06), respectively. After adjusting for confounding factors, with high RDW linked to an increase in mortality (RDW 15.7-21.2% versus 11.1-13.4%: OR, 1.57; 95% CI, 1.22 to 2.01; P trend <0.0001). A similar trend was observed for 30-day mortality. Conclusions. RDW appeared to be an independent prognostic marker in critically ill patients with AKI and higher RDW was associated with increased risk of mortality in these patients.

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