Transfusion policy and outcome in critically ill patients with a long ICU stay

Introduction

Patients with a long ICU stay (>7 days) are prone to develop anemia due to high severity of disease, repeated flebotomies and inflammatory status with altered erythropoiesis. They are also more prone to receive a blood transfusion. The aim of our study was to assess the hemoglobin (Hb) transfusion trigger and the influence of blood transfusion on outcome in critically ill patients with an ICU length of stay (LOS) >7 days.

Methods

The prospective noninterventional study was performed in a mixed 19-bed ICU of a tertiary care university hospital and included all patients with an ICU LOS > 7 days admitted during 1 year. Patients were divided into two groups: patients never transfused (NT group), and patients ever transfused (ET group). Collected data were demographic data, severity scores, Hb transfusion trigger, transfusion data, ICU LOS and outcome. Statistical analysis was conducted using the Student t test and multinomial logistic regression.

Results

The study enrolled 132 patients (NT, 54 patients; ET, 78 patients) with a mean ICU LOS 12.9 days, a mean worst APACHE II score 22.8 and a mean worst SOFA score 9.3. Anemia (Hb < 12 g%) was present in 83.3% patients at ICU admission and in 95.4% at ICU discharge. In the ET group the transfusion trigger Hb was 7.8 ± 2.3 g%. In the ET group a total of 228 red blood cell units were transfused on 154 different occasions with a median of 2 (1–16) units/patient. The mortality was significantly different in the ET group (51 patients, 65.3%) versus the NT group (11 patients, 20.7%). Mortality significantly correlates with worst SOFA score (P = 0.041) and mostly with transfusion status (P = 0.002). See Table 1.

Table 1 Patient data

Conclusion

The incidence of anemia in critically ill patients with a long ICU stay is high (83% at ICU admission, 95% at ICU discharge). The transfusion trigger Hb was 7.8 g%, a value that matches the actual restrictive policy. Blood transfusion was an independent risk factor for increased mortality in the ET group.