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Observational Study
. 2020 Apr 20;24(1):160.
doi: 10.1186/s13054-020-2827-5.

Using arterial-venous oxygen difference to guide red blood cell transfusion strategy

Alberto Fogagnolo #  1 , Fabio Silvio Taccone #  2 , Jean Louis Vincent  2 , Giulia Benetto  1 , Elaine Cavalcante  2 , Elisabetta Marangoni  1 , Riccardo Ragazzi  1 , Jacques Creteur  2 , Carlo Alberto Volta  1 , Savino Spadaro  3
Affiliations
Observational Study

Using arterial-venous oxygen difference to guide red blood cell transfusion strategy

Alberto Fogagnolo et al. Crit Care. .

Erratum in

Abstract

Background: Guidelines recommend a restrictive red blood cell transfusion strategy based on hemoglobin (Hb) concentrations in critically ill patients. We hypothesized that the arterial-venous oxygen difference (A-V O2diff), a surrogate for the oxygen delivery to consumption ratio, could provide a more personalized approach to identify patients who may benefit from transfusion.

Methods: A prospective observational study including 177 non-bleeding adult patients with a Hb concentration of 7.0-10.0 g/dL within 72 h after ICU admission. The A-V O2diff, central venous oxygen saturation (ScvO2), and oxygen extraction ratio (O2ER) were noted when a patient's Hb was first within this range. Transfusion decisions were made by the treating physician according to institutional policy. We used the median A-V O2diff value in the study cohort (3.7 mL) to classify the transfusion strategy in each patient as "appropriate" (patient transfused when the A-V O2diff > 3.7 mL or not transfused when the A-V O2diff ≤ 3.7 mL) or "inappropriate" (patient transfused when the A-V O2diff ≤ 3.7 mL or not transfused when the A-V O2diff > 3.7 mL). The primary outcome was 90-day mortality.

Results: Patients managed with an "appropriate" strategy had lower mortality rates (23/96 [24%] vs. 36/81 [44%]; p = 0.004), and an "appropriate" strategy was independently associated with reduced mortality (hazard ratio [HR] 0.51 [95% CI 0.30-0.89], p = 0.01). There was a trend to less acute kidney injury with the "appropriate" than with the "inappropriate" strategy (13% vs. 26%, p = 0.06), and the Sequential Organ Failure Assessment (SOFA) score decreased more rapidly (p = 0.01). The A-V O2diff, but not the ScvO2, predicted 90-day mortality in transfused (AUROC = 0.656) and non-transfused (AUROC = 0.630) patients with moderate accuracy. Using the ROC curve analysis, the best A-V O2diff cutoffs for predicting mortality were 3.6 mL in transfused and 3.5 mL in non-transfused patients.

Conclusions: In anemic, non-bleeding critically ill patients, transfusion may be associated with lower 90-day mortality and morbidity in patients with higher A-V O2diff.

Trial registration: ClinicalTrials.gov, NCT03767127. Retrospectively registered on 6 December 2018.

Keywords: Critical care; Mortality; Oxygen consumption; Red blood cell transfusion.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Ninety-day mortality in transfused and non-transfused patients in each group
Fig. 2
Fig. 2
Cox regression analysis for 90-day mortality in the “appropriate” and “inappropriate” groups
Fig. 3
Fig. 3
Ninety-day mortality in transfused and non-transfused patients according to quartiles of arterial-venous oxygen difference (A-V O2diff) and O2 extraction ratio
See this image and copyright information in PMC

References

    1. Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001;120(4):1262–1270. doi: 10.1378/chest.120.4.1262. - DOI - PubMed
    1. Malhotra R, Kashani KB, Macedo E, Kim J, Bouchard J, Wynn S, Li G, Ohno-Machado L, Mehta R. A risk prediction score for acute kidney injury in the intensive care unit. Nephrol Dial Transplant. 2017;32(5):814–822. doi: 10.1093/ndt/gfx026. - DOI - PubMed
    1. Rasmussen L, Christensen S, Lenler-Petersen P, Johnsen SP. Anemia and 90-day mortality in COPD patients requiring invasive mechanical ventilation. Clin Epidemiol. 2010;3:1–5. - PMC - PubMed
    1. Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion. 2002;42(7):812–818. doi: 10.1046/j.1537-2995.2002.00123.x. - DOI - PubMed
    1. Vlaar AP, Wolthuis EK, Hofstra JJ, Roelofs JJ, Boon L, Schultz MJ, Lutter R, Juffermans NP. Mechanical ventilation aggravates transfusion-related acute lung injury induced by MHC-I class antibodies. Intensive Care Med. 2010;36(5):879–887. doi: 10.1007/s00134-010-1802-z. - DOI - PubMed

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