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Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis*

Authors
Park, DW; Chun, BC; Kwon, SS; Yoon, YK; Choi, WS; Sohn, JW; Peck, KR; Kim, YS; Choi, YH; Choi, JY; Kim, SI; Eom, JS; Kim, HY; Cheong, HJ; Song, YG; Choi, HJ; Kim, JM; Kim, MJ
Citation
Critical care medicine, 40(12):3140-3145, 2012
Journal Title
Critical care medicine
ISSN
0090-34931530-0293
Abstract
OBJECTIVES: To evaluate the effects of transfusions in patients with severe sepsis and septic shock on mortality.



DESIGN: Propensity-matched analysis of a prospective observational database (April 2005 to February 2009).



SETTING: Twenty-two medical and surgical intensive care units in 12 teaching hospitals in Korea.



PATIENTS: One thousand fifty-four patients with community-acquired severe sepsis and septic shock.



INTERVENTIONS: None.



MEASUREMENTS AND MAIN RESULTS: Of the 1,054 patients, 407 (38.6%) received a blood transfusion. The mean pretransfusion hemoglobin level was 7.7 ± 1.2 g/dL. Transfused patients had higher 28-day and in-hospital mortality rates (32.7% vs. 17.3%; p < .001, 41.3% vs. 20.3%; p < .001, respectively) and a longer duration of hospital stay (21 [interquartile range, 10-35] vs. 13 [interquartile range, 8-24] days; p < .001), but were more severely ill at admission (lower systolic blood pressure, higher Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score at admission). In 152 pairs matched according to the propensity score depending on patient transfusion status, transfused patients had a lower risk of 7-day (9.2% vs. 27.0%; p < .001), 28-day (24.3% vs. 38.8%; p = .007), and in-hospital mortality rates (31.6% vs. 42.8%; p = .044). After adjusting for blood transfusion as a time-dependent variable in multivariable analysis, blood transfusion was independently associated with lower risk of 7-day (hazard ratio 0.42, 95% confidence interval 0.19-0.50, p = .026), 28-day (hazard ratio 0.43, 95% confidence interval 0.29-0.62, p < .001), and in-hospital mortality (hazard ratio 0.51, 95% confidence interval 0.39-0.69, p < .001).



CONCLUSIONS: In this observational study of patients with community-acquired severe sepsis and septic shock, red blood cell transfusions were associated with lower risk of mortality.
MeSH terms
AgedCommunity-Acquired Infections/mortalityErythrocyte Transfusion/*mortalityFemaleHospitals, TeachingHumans*Intensive Care UnitsMaleMiddle AgedPropensity ScoreProspective StudiesRepublic of Korea/epidemiologyRisk Assessment
DOI
10.1097/CCM.0b013e3182657b75
PMID
22975891
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Infectious Diseases
AJOU Authors
최, 영화
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