Red cell pack use and mortality rate in Brazilian septic patients: Sepsis Brazil study

Background

Anemia in the setting of critical illness is quite prevalent, with 37–44% of patients receiving at least one blood transfusion during their ICU stay [1, 2]. In one representative study [3], 85% of patients with an ICU length of stay greater than 1 week received at least one blood transfusion. In more than two-thirds of these cases blood transfusion was not associated with acute blood loss.

Objective

To compare packed red blood cell (RBC) transfusion in septic patients and the mortality rate in septic patients.

Methods

We conducted a prospective cohort study in 65 hospitals of all regions of Brazil. The patients who were admitted or who developed sepsis during September 2003 were enrolled. They were followed until the 28th day. Sepsis diagnosis was made in accordance with the criteria proposed by ACCP/SCCM in 1992. We evaluated demographic features, APACHE II score, SOFA score, mortality, sources of infections, microbiology and interventions. We also recorded underlying diseases and length of stay.

Results

A total of 3128 patients were identified and 526 (16.8%) filled the criteria of sepsis, severe sepsis or septic shock. Two hundred and thirty-three patients (44.7%) received a RBC transfusion and 288 did not (55.3%). Five patients were excluded (three lost to follow-up and two lack RBC transfusion registry). One hundred and eighteen patients (50.6%) of the transfused group were dead on the 28th day; 115 (49.4%) were alive. One hundred and twenty-five patients (43.4%) of the nontransfused group were dead on the 28th day; 163 (56.6%) were alive. The APACHE II score in both groups was 20, with an expected mortality rate of 40%.

Conclusion

RBC transfusion made no difference in the 28-day mortality rate (the number of patients dead or alive with RBC transfusion was almost the same). In the nontransfused group the number of patients alive on the 28th follow-up day is greater then the number of dead patients.