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Observational Study
. 2025 Dec;65(12):2272-2285.
doi: 10.1111/trf.18445. Epub 2025 Oct 22.

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

Vincent C Kurucz  1 , Andrew W J Flint  2   3 , Alexis Poole  3 , Merijn C Reuland  1 , Claudia van den Oord  1 , Caroline M Schaap  1 , Jan Bakker  4   5   6   7 , Maurizio Cecconi  8 , Aarne Feldheiser  9 , Jens Meier  10 , Zoe McQuilten  2   3 , Marcella C A Müller  1 , Sanne de Bruin  1 , Thomas W L Scheeren  11 , Tarikul Hamid  12 , Cécile Aubron  13 , Michaël Piagnerelli  14 , Tina Tomić Mahečić  15 , Jan Benes  16 , Lene Russell  17   18   19 , Hernan Aguirre-Bermeo  20 , Konstantina Triantafyllopoulou  21 , Vasiliki Chantziara  22 , Mohan Gurjar  23 , Sheila Nainan Myatra  24 , Vincenzo Pota  25 , Muhammed Elhadi  26 , Ryszard Gawda  27 , Mafalda Mourisco  28 , Marcus Lance  29 , Vojislava Neskovic  30 , Matej Podbregar  31 , Juan V Llau  32 , Manual Quintana-Diaz  33 , Maria Cronhjort  34 , Carmen A Pfortmueller  35 , Nihan Yapici  36 , Nathan Nielsen  37 , Akshay Shah  38 , Harm-Jan de Grooth  1   39 , Alexander P J Vlaar  1 , Jimmy Schenk  1   40 , Senta Jorinde Raasveld  1   41 ; InPUT Study Group
Affiliations
Observational Study

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 Dec.

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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Conflict of interest statement

Dr. Cecconi reported receiving personal fees from Edwards Lifesciences, GE Healthcare, and Directed Systems outside the submitted work. Dr. Shah reported receiving consultancy fees from Pharmacosmos UK outside of the submitted work. Dr. Feldheiser reported receiving personal fees from Baxter and Medtronic outside the submitted work. Dr. Scheeren reported serving as senior medical director for Edwards Lifesciences (Garching, Germany). Dr. McQuilten reported receiving grants from Australian National Blood Authority and National Health and Medical Research Council during the conduct of the study. Dr. Flint reported receiving grants from the Australian National Blood Authority and Blood Synergy (Monash University) during the conduct of the study. Dr. Piagnerelli reported receiving grants from Centre Federal d'Expertise Belge–KCE grant for COVID‐19 study outside the submitted work. Dr. Gurjar reported receiving royalties for edited books (Manual of ICU Procedures and Textbook of Ventilation, Fluids, Electrolytes and Blood Gases) from the publisher Jaypee Brothers Medical Publishers (Pvt) Ltd., New Delhi. Dr. Pfortmueller reported receiving grants from Orion Pharma, Abbott Nutrition International, B Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd., Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica SA, Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, GlaxoSmithKline, Merck Sharp and Dohme AG, Eli Lilly and Co, Baxter, Boehringer Ingelheim, Aseptuva, Astellas, AstraZeneca, CSL Behring, Novartis, Covidien, and Nycomed outside the submitted work; the funds were paid into departmental funds and no personal financial gain applied. Dr. Nielsen reported receiving personal fees from Adrenomed outside the submitted work. Dr. Vlaar reported receiving personal fees from a Vidi grant (ZonMW: 09150172010047). No other disclosures were reported.

Figures

FIGURE 1
FIGURE 1
Study participants' pathway: from inclusion to transfusion events. RBC, red blood cell.
FIGURE 2
FIGURE 2
(A–C) Clinical reasons for red blood cell (RBC)/platelet/plasma transfusions multiple reasons for transfusion could be recorded per event. Other reasons included: Platelet transfusions;coagulopathy (N = 3), during surgery (N = 1), at the discretion of the hematology department (N = 1). Plasma transfusions;(low platelet count (N = 4), COVID‐19 (N = 3) (Coronavirus Disease 2019), low hemoglobin (N = 1). VHA, visoelastic hemostatic assay.
FIGURE 3
FIGURE 3
(A) A violin plot with boxplot overlay illustrating the distribution of minimum hemoglobin (Hb) levels by transfusion status, with the red blood cell transfused group shown in red and the non‐transfused group in blue. (B) A violin plot with boxplot overlay illustrating the distribution of minimum platelet count levels by transfusion status, with the platelet‐transfused group shown in red and the nontransfused group in blue. Abbreviations: RBC, red blood cell; plt, platelet count.
See this image and copyright information in PMC

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