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. 2017 Dec;7(1):62.
doi: 10.1186/s13613-017-0292-3. Epub 2017 Jun 12.

Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies

Adrien Mirouse  1 , Matthieu Resche-Rigon  2 , Virginie Lemiale  3 , Djamel Mokart  4 , Achille Kouatchet  5 , Julien Mayaux  6 , François Vincent  7 , Martine Nyunga  8 , Fabrice Bruneel  9 , Antoine Rabbat  10 , Christine Lebert  11 , Pierre Perez  12 , Anne Renault  13 , Anne-Pascale Meert  14 , Dominique Benoit  15 , Rebecca Hamidfar  16 , Mercé Jourdain  17 , Michaël Darmon  18 , Elie Azoulay  3 , Frédéric Pène  19 ; Groupe de Recherche sur la Réanimation Respiratoire en Onco-Hématologie (Grrr-OH)
Affiliations

Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies

Adrien Mirouse et al. Ann Intensive Care. 2017 Dec.

Abstract

Background: Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies.

Methods: We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010-2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation.

Results: Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1-3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03-2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05-2.57], p = 0.03) analysis.

Conclusions: RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death.

Keywords: Anemia; Hematological malignancy; Red blood cell transfusion; Septic shock; Severe sepsis.

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Figures

Fig. 1
Fig. 1
Hemoglobin levels in non-transfused (n = 421) and transfused (n = 210) patients. ICU intensive care unit, RBC red blood cell
Fig. 2
Fig. 2
Survival estimates in non-transfused and transfused patients. Crude (a) and propensity score-adjusted (b) survival estimates in patients who did or did not receive red blood cell transfusion during the first two days of resuscitation. a Encompasses the whole cohort (631 patients distributed into 421 non-transfused and 210 transfused). b Includes 142 transfused patients with 142 propensity score-matched non-transfused counterparts. ICU intensive care unit
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