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

Dae Won Park, Byung-Chul Chun, Soon Sun Kwon, Young Kyung Yoon, Wonseok Choi, Jang Wook Sohn, Kyong Ran Peck, Yang Soo Kim, Young Hwa Choi, Jun Yong Choi, Sang Il Kim, Joong Sik Eom, Hyo Youl Kim, Hee-Jin Cheong, Young Goo Song, Hee Jung Choi, June Myung Kim, Ja Kim Min

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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.

Original languageEnglish
Pages (from-to)3140-3145
Number of pages6
JournalCritical Care Medicine
Volume40
Issue number12
DOIs
Publication statusPublished - 2012 Dec 1

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Erythrocyte Transfusion
Septic Shock
Sepsis
Mortality
Hospital Mortality
Blood Transfusion
Confidence Intervals
Organ Dysfunction Scores
Blood Pressure
Propensity Score
APACHE
Critical Care
Korea
Teaching Hospitals
Observational Studies
Intensive Care Units
Length of Stay
Hemoglobins
Databases

Keywords

  • blood transfusion
  • mortality
  • septic shock
  • severe sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock : A propensity-matched analysis. / Park, Dae Won; Chun, Byung-Chul; Kwon, Soon Sun; Yoon, Young Kyung; Choi, Wonseok; Sohn, Jang Wook; Peck, Kyong Ran; Kim, Yang Soo; Choi, Young Hwa; Choi, Jun Yong; Kim, Sang Il; Eom, Joong Sik; Kim, Hyo Youl; Cheong, Hee-Jin; Song, Young Goo; Choi, Hee Jung; Kim, June Myung; Min, Ja Kim.

In: Critical Care Medicine, Vol. 40, No. 12, 01.12.2012, p. 3140-3145.

Research output: Contribution to journalArticle

Park, Dae Won ; Chun, Byung-Chul ; Kwon, Soon Sun ; Yoon, Young Kyung ; Choi, Wonseok ; Sohn, Jang Wook ; Peck, Kyong Ran ; Kim, Yang Soo ; Choi, Young Hwa ; Choi, Jun Yong ; Kim, Sang Il ; Eom, Joong Sik ; Kim, Hyo Youl ; Cheong, Hee-Jin ; Song, Young Goo ; Choi, Hee Jung ; Kim, June Myung ; Min, Ja Kim. / Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock : A propensity-matched analysis. In: Critical Care Medicine. 2012 ; Vol. 40, No. 12. pp. 3140-3145.
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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.",
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author = "Park, {Dae Won} and Byung-Chul Chun and Kwon, {Soon Sun} and Yoon, {Young Kyung} and Wonseok Choi and Sohn, {Jang Wook} and Peck, {Kyong Ran} and Kim, {Yang Soo} and Choi, {Young Hwa} and Choi, {Jun Yong} and Kim, {Sang Il} and Eom, {Joong Sik} and Kim, {Hyo Youl} and Hee-Jin Cheong and Song, {Young Goo} and Choi, {Hee Jung} and Kim, {June Myung} and Min, {Ja Kim}",
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TY - JOUR

T1 - Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock

T2 - A propensity-matched analysis

AU - Park, Dae Won

AU - Chun, Byung-Chul

AU - Kwon, Soon Sun

AU - Yoon, Young Kyung

AU - Choi, Wonseok

AU - Sohn, Jang Wook

AU - Peck, Kyong Ran

AU - Kim, Yang Soo

AU - Choi, Young Hwa

AU - Choi, Jun Yong

AU - Kim, Sang Il

AU - Eom, Joong Sik

AU - Kim, Hyo Youl

AU - Cheong, Hee-Jin

AU - Song, Young Goo

AU - Choi, Hee Jung

AU - Kim, June Myung

AU - Min, Ja Kim

PY - 2012/12/1

Y1 - 2012/12/1

N2 - 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.

AB - 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.

KW - blood transfusion

KW - mortality

KW - septic shock

KW - severe sepsis

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