Anemia and blood transfusion in a surgical Intensive Care Unit

Department of Anesthesiology and Intensive Care, Friedrich Schiller University Hospital, Erlanger Allee 103, Jena 07743, Germany.
Critical care (London, England) (Impact Factor: 4.48). 05/2010; 14(3):R92. DOI: 10.1186/cc9026
Source: PubMed


Studies 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.
We retrospectively analyzed the prospectively collected data from all adult patients (>18 years old) admitted to a 50-bed surgical ICU between 1st March 2004 and 30th July 2006.
Of 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 0.97[0.95-0.98], per 1 g/dl, p < 0.001) and blood transfusions (RR 0.96[0.92-0.99], 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.
In 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.

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    • "Moreover when patients were matched by propensity scoring in the SOAP cohort, RBC transfusion was associated with improved outcome [14]. These results are supported by data from a single, surgical ICU [15] and a cohort of patients with community-acquired severe sepsis from multiple ICUs [10]. It may be questioned if any of the statistical models used are valid to adjust for the obvious differences between transfused and non-transfused in cohorts of ICU patients. "
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    • "Dr Sakr and colleagues [1] report a single centre cohort study evaluating the relationship between anaemia, blood transfusions and mortality in patients admitted to a surgical ICU. The authors report some findings that are not new or surprising, namely that anaemia is associated with adverse patient outcomes. "
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