Predicting organ functioning with and without blood transfusion in critically ill patients with anemia

Transfusion, vol. 62, pp. 1527–1536

Abstract

BACKGROUND: To develop a model for the prediction of the (most likely) effect of red blood cell (RBC) transfusion on subsequent organ functioning in nonbleeding critically ill patients with hemoglobin concentrations between 6 and 9 g/dL. STUDY DESIGN AND METHODS: We conducted a retrospective cohort study using electronic health care data of nonbleeding patients admitted between November 2004 and May 2016 at the intensive care unit (ICU) of the Leiden University Medical Center, The Netherlands. We analyzed the associations between transfusion (yes/no) and next-day SOFA scores (Sequential Organ Failure Assessment-as a measure for organ functioning) for all observed combinations of hemoglobin values (between 6 and 9 g/dL) and concurrent clinical variables. RESULTS: Data of 6425 ICU admission of 5756 critically ill patients with 28,702 hemoglobin values between 6 and 9 g/dL (transfusion decision moments) of which 22.1% were followed by a transfusion were analyzed. The adjusted average difference between the next-day SOFA score of transfused versus not-transfused patients was 0.08 (95% confidence interval [CI] -0.03 to 0.18). At singular transfusion decision moments, the score predicted a beneficial effect of transfusion on next-day SOFA score for some subgroups and medical conditions and a harmful effect in other occasions. CONCLUSIONS: Among these critically ill patients with hemoglobin concentrations between 6 and 9 g/dL the population average effect of transfusion on the next SOFA score was negligible. Further, our results support caution in clinical decision-making regarding transfusion of critical ill, nonbleeding ICU patients.

Authors 6

1. Floris J. Kranenburg Aachen Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands Department of Intensive Care Medicine Leiden University Medical Center Leiden The Netherlands Center for Clinical Transfusion Research Department of Clinical Epidemiology Department of Intensive Care Medicine

   Leiden University Medical Center · Sanquin · Jon J van Rood Centre for Clinical Transfusion Research

   Affiliation as printed

   Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands

   Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands

   Department of Intensive Care Medicine Leiden University Medical Center Leiden The Netherlands

   Center for Clinical Transfusion Research, Sanquin Research Leiden, The Netherlands

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

   Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands

2. M. Sesmu Arbous Aachen Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands Department of Intensive Care Medicine Leiden University Medical Center Leiden The Netherlands Department of Clinical Epidemiology Department of Intensive Care Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands

   Department of Intensive Care Medicine Leiden University Medical Center Leiden The Netherlands

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

   Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands

3. Camila Caram‐Deelder Aachen Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands Center for Clinical Transfusion Research

   Sanquin · Jon J van Rood Centre for Clinical Transfusion Research

   Affiliation as printed

   Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands

   Center for Clinical Transfusion Research, Sanquin Research Leiden, The Netherlands

4. Hein Putter Aachen Department of Medical Statistics and Bioinformatics Leiden University Medical Center Leiden The Netherlands Department of Medical Statistics and Bioinformatics

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Statistics and Bioinformatics Leiden University Medical Center Leiden The Netherlands

   Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

5. Saskia le Cessie Aachen Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands Department of Medical Statistics and Bioinformatics Leiden University Medical Center Leiden The Netherlands Department of Clinical Epidemiology Department of Medical Statistics and Bioinformatics

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands

   Department of Medical Statistics and Bioinformatics Leiden University Medical Center Leiden The Netherlands

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

   Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

6. Johanna G. van der Bom corresponding Aachen Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands Center for Clinical Transfusion Research Department of Clinical Epidemiology

   Leiden University Medical Center · Sanquin · Jon J van Rood Centre for Clinical Transfusion Research

   Affiliation as printed

   Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands

   Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands

   Center for Clinical Transfusion Research, Sanquin Research Leiden, The Netherlands

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands