Worldwide audit of blood transfusion practice in critically ill patients

Abstract

Background: The aim was to describe transfusion practice in critically ill patients at an international level and evaluate the effects of red blood cell (RBC) transfusion on outcomes in these patients.

Methods: This was a pre-planned sub-study of the Intensive Care Over Nations audit, which involved 730 ICUs in 84 countries and included all adult patients admitted between 8 May and 18 May 2012, except admissions for routine postoperative surveillance.

Results: ICU and hospital outcomes were recorded. Among the 10,069 patients included in the audit, data related to transfusion had been completed for 9553 (mean age 60 ± 18 years, 60% male); 2511 (26.3%) of these had received a transfusion, with considerable variation among geographic regions. The mean lowest hemoglobin on the day of transfusion was 8.3 ± 1.7 g/dL, but varied from 7.8 ± 1.4 g/dL in the Middle East to 8.9 ± 1.9 g/dL in Eastern Europe. Hospital mortality rates were higher in transfused than in non-transfused patients (30.0% vs. 19.6%, p < 0.001) and increased with increasing numbers of transfused units. In an extended Cox proportional hazard analysis, the relative risk of in-hospital death was slightly lower after transfusion in the whole cohort (hazard ratio 0.98, confidence interval 0.96-1.00, p = 0.048). There was a stepwise decrease in the hazard ratio for mortality after transfusion with increasing admission severity scores.

Conclusions: More than one fourth of critically ill patients are transfused during their ICU stay, with considerable variations in transfusion practice among geographic regions. After adjustment for confounders, RBC transfusions were associated with a slightly lower relative risk of in-hospital death, especially in the most severely ill patients, highlighting the importance of taking the severity of illness into account when making transfusion decisions.

Keywords: Red blood cell; Severity of illness; Worldwide.

Fig. 1

Distribution of hemoglobin concentrations in the different geographic regions on admission (upper panel) and during the ICU stay (lower panel)

Fig. 2

Proportion of patients who received a red blood cell (RBC) transfusion during the ICU stay in the different geographic regions. Hb, hemoglobin

Fig. 3

Forest plot was created from modelling of our observational data showing the risk of in-hospital death after transfusion in the various subgroups of patients. SAPS, Simplified Acute Physiology Score; SOFA, Sequential Organ Failure Assessment (on admission)