Global transfusion practices in septic patients in the intensive care unit: insights from the InPUT-study sub-analysis

Vincent C Kurucz¹, Andrew W J Flint^{2

3}, Alexis Poole³, Merijn C Reuland¹, Claudia van den Oord¹, Caroline M Schaap¹, Jan Bakker^{4

5

6

7}, Maurizio Cecconi⁸, Aarne Feldheiser⁹, Jens Meier¹⁰, Zoe McQuilten^{2

3}, Marcella C A Müller¹, Sanne de Bruin¹, Thomas W L Scheeren¹¹, Tarikul Hamid¹², Cécile Aubron¹³, Michaël Piagnerelli¹⁴, Tina Tomić Mahečić¹⁵, Jan Benes¹⁶, Lene Russell^{17

18

19}, Hernan Aguirre-Bermeo²⁰, Konstantina Triantafyllopoulou²¹, Vasiliki Chantziara²², Mohan Gurjar²³, Sheila Nainan Myatra²⁴, Vincenzo Pota²⁵, Muhammed Elhadi²⁶, Ryszard Gawda²⁷, Mafalda Mourisco²⁸, Marcus Lance²⁹, Vojislava Neskovic³⁰, Matej Podbregar³¹, Juan V Llau³², Manual Quintana-Diaz³³, Maria Cronhjort³⁴, Carmen A Pfortmueller³⁵, Nihan Yapici³⁶, Nathan Nielsen³⁷, Akshay Shah³⁸, Harm-Jan de Grooth^{1

39}, Alexander P J Vlaar¹, Jimmy Schenk^{1

40}, Senta Jorinde Raasveld^{1

41}; InPUT Study Group

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
² Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³ The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁴ Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, The Netherlands.
⁵ Department of Pulmonary and Critical Care, New York University, New York, New York, USA.
⁶ Department of Pulmonary and Critical Care, Columbia University, New York, New York, USA.
⁷ Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁸ Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
⁹ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany.
¹⁰ Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria.
¹¹ Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands.
¹² Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh.
¹³ Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France.
¹⁴ Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium.
¹⁵ Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Zagreb, Croatia.
¹⁶ Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen-Charles University, Plzen, Czech Republic.
¹⁷ Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark.
¹⁸ Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital-Gentofte, Hellerup, Denmark.
¹⁹ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁰ Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
²¹ Department of Cardiothoracic Surgery, European Interbalkan Medical Center, Thessaloniki, Greece.
²² Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece.
²³ Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
²⁴ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
²⁵ Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy.
²⁶ Faculty of Medicine, University of Tripoli, Tripoli, Libya.
²⁷ Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.
²⁸ Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal.
²⁹ Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya.
³⁰ Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia.
³¹ Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
³² Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain.
³³ Intensive Care Service, Hospital Universitario La Paz, Madrid, Spain.
³⁴ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
³⁵ Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
³⁶ Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey.
³⁷ Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
³⁸ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
³⁹ Department of Intensive Care, Utrecht University Medical Centers, Utrecht, The Netherlands.
⁴⁰ Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location AMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.
⁴¹ Department of Anesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

PMID: 41122832
DOI: 10.1111/trf.18445

Global transfusion practices in septic patients in the intensive care unit: insights from the InPUT-study sub-analysis

Vincent C Kurucz et al. Transfusion. 2025.

. 2025 Oct 22.

doi: 10.1111/trf.18445. Online ahead of print.

Authors

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
² Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³ The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁴ Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, The Netherlands.
⁵ Department of Pulmonary and Critical Care, New York University, New York, New York, USA.
⁶ Department of Pulmonary and Critical Care, Columbia University, New York, New York, USA.
⁷ Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁸ Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
⁹ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany.
¹⁰ Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria.
¹¹ Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands.
¹² Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh.
¹³ Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France.
¹⁴ Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium.
¹⁵ Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Zagreb, Croatia.
¹⁶ Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen-Charles University, Plzen, Czech Republic.
¹⁷ Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark.
¹⁸ Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital-Gentofte, Hellerup, Denmark.
¹⁹ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁰ Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
²¹ Department of Cardiothoracic Surgery, European Interbalkan Medical Center, Thessaloniki, Greece.
²² Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece.
²³ Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
²⁴ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
²⁵ Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy.
²⁶ Faculty of Medicine, University of Tripoli, Tripoli, Libya.
²⁷ Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.
²⁸ Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal.
²⁹ Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya.
³⁰ Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia.
³¹ Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
³² Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain.
³³ Intensive Care Service, Hospital Universitario La Paz, Madrid, Spain.
³⁴ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
³⁵ Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
³⁶ Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey.
³⁷ Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
³⁸ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
³⁹ Department of Intensive Care, Utrecht University Medical Centers, Utrecht, The Netherlands.
⁴⁰ Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location AMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.
⁴¹ Department of Anesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

PMID: 41122832
DOI: 10.1111/trf.18445

Abstract

Background: Transfusion practices among intensive care unit (ICU) patients with sepsis vary widely. While restrictive hemoglobin thresholds for red blood cell (RBC) transfusion are well studied, the indications and thresholds for platelet and plasma transfusions remain uncertain.

Methods: We performed a sepsis-specific sub-analysis of the International Point Prevalence Study of Intensive Care Unit Transfusion Practices, a prospective, multicenter, observational study capturing all adult ICU admissions during four pre-scheduled weeks between March 2019 and October 2022. Patients admitted with sepsis or septic shock, or who developed sepsis during their ICU stay, were included. We recorded demographics, daily laboratory values, and transfusion triggers. Primary endpoints were the proportions of patients receiving RBCs, platelets, or plasma; secondary endpoints were indications, pre-transfusion thresholds, and blood loss.

Results: Among 3643 screened patients, 799 (22%) fulfilled sepsis criteria; within this subgroup, 317 (40%) received at least one blood component. RBCs were transfused in 269 patients (34%), primarily to address anemia or hemodynamic instability, at a mean pre-transfusion hemoglobin of 7.5 ± 1.4 g/dL, consistent with restrictive practice. Platelets were given to 78 patients (10%) for prophylaxis or active bleeding at a median count of 26 × 10⁹ cells/L (interquartile range 16-51 × 10⁹ cells/L). Plasma was administered to 108 patients (14%), half for bleeding control and half for non-bleeding indications.

Conclusions: This largest international snapshot of septic ICU transfusion practices confirms adherence to restrictive RBC thresholds but reveals substantial variability in platelet and plasma use. These findings underscore the need for targeted trials to refine transfusion guidelines in sepsis.

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References

REFERENCES

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Global transfusion practices in septic patients in the intensive care unit: insights from the InPUT-study sub-analysis

Affiliations

Global transfusion practices in septic patients in the intensive care unit: insights from the InPUT-study sub-analysis

Authors

Affiliations

Abstract

References

REFERENCES

Grants and funding

LinkOut - more resources

Full Text Sources