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Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock

Parsons, EC and Hough, CL and Seymour, CW and Cooke, CR and Rubenfeld, GD and Watkins, TR (2011) Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock. Critical Care, 15 (5). ISSN 1364-8535

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Abstract

Introduction: In this study, we sought to determine the association between red blood cell (RBC) transfusion and outcomes in patients with acute lung injury (ALI), sepsis and shock.Methods: We performed a secondary analysis of new-onset ALI patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial (2000 to 2005) who had a documented ALI risk factor of sepsis or pneumonia and met shock criteria (mean arterial pressure (MAP) < 60 mmHg or vasopressor use) within 24 hours of randomization. Using multivariable logistic regression, we examined the association between RBC transfusion and 28-day mortality after adjustment for age, sex, race, randomization arm and Acute Physiology and Chronic Health Evaluation III score. Secondary end points included 90-day mortality and ventilator-free days (VFDs). Finally, we examined these end points among the subset of subjects meeting prespecified transfusion criteria defined by five simultaneous indicators: hemoglobin < 10.2 g/dL, central or mixed venous oxygen saturation < 70%, central venous pressure ≥ 8 mmHg, MAP ≥ 65 mmHg, and vasopressor use.Results: We identified 285 subjects with ALI, sepsis, shock and transfusion data. Of these, 85 also met the above prespecified transfusion criteria. Fifty-three (19%) of the two hundred eighty-five subjects with shock and twenty (24%) of the subset meeting the transfusion criteria received RBC transfusion within twenty-four hours of randomization. We found no independent association between RBC transfusion and 28-day mortality (odds ratio = 1.49, 95% CI (95% confidence interval) = 0.77 to 2.90; P = 0.23) or VFDs (mean difference = -0.35, 95% CI = -4.03 to 3.32; P = 0.85). Likewise, 90-day mortality and VFDs did not differ by transfusion status. Among the subset of patients meeting the transfusion criteria, we found no independent association between transfusion and mortality or VFDs.Conclusions: In patients with new-onset ALI, sepsis and shock, we found no independent association between RBC transfusion and mortality or VFDs. The physiological criteria did not identify patients more likely to be transfused or to benefit from transfusion. © 2011 Parsons et al. licensee BioMed Central Ltd.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Parsons, EC
Hough, CL
Seymour, CWseymourc@pitt.eduSEYMOURC0000-0002-6257-6764
Cooke, CR
Rubenfeld, GD
Watkins, TR
Date: 21 September 2011
Date Type: Publication
Journal or Publication Title: Critical Care
Volume: 15
Number: 5
DOI or Unique Handle: 10.1186/cc10458
Schools and Programs: School of Medicine > Critical Care Medicine
School of Medicine > Emergency Medicine
Refereed: Yes
ISSN: 1364-8535
Date Deposited: 31 Oct 2016 16:42
Last Modified: 06 Oct 2020 18:55
URI: http://d-scholarship.pitt.edu/id/eprint/30020

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