Context Anemia is a common problem in critically ill patients
admitted to intensive care units (ICUs), but the consequences
of anemia on morbidity and mortality in the critically ill is
poorly defined.
Objectives To prospectively define the incidence of anemia
and use of red blood cell (RBC) transfusions in critically ill
patients and to explore the potential benefits and risks associated
with transfusion in the ICU.
Design Prospective observational study conducted November
1999, with 2 components: a blood sampling study and an anemia
and blood transfusion study.
Setting and Patients The blood sampling study included
1136 patients from 145 western European ICUs, and the anemia
and blood transfusion study included 3534 patients from 146
western European ICUs. Patients were followed up for 28 days
or until hospital discharge, interinstitutional transfer, or
death.
Main Outcome Measures Frequency of blood drawing and associated
volume of blood drawn, collected over a 24-hour period; hemoglobin
levels, transfusion rate, organ dysfunction (assessed using
the Sequential Organ Failure Assessment score), and mortality,
collected throughout a 2-week period.
Results The mean (SD) volume per blood draw was 10.3 (6.6)
mL, with an average total volume of 41.1 (39.7) mL during the
24-hour period. There was a positive correlation between organ
dysfunction and the number of blood draws (
r = 0.34;
P<.001)
and total volume drawn (
r = 0.28;
P<.001). The mean hemoglobin
concentration at ICU admission was 11.3 (2.3) g/dL, with 29%
(963/3295) having a concentration of less than 10 g/dL. The
transfusion rate during the ICU period was 37.0% (1307/3534).
Older patients and those with a longer ICU length of stay were
more commonly transfused. Both ICU and overall mortality rates
were significantly higher in patients who had vs had not received
a transfusion (ICU rates: 18.5% vs 10.1%, respectively;
2 =
50.1;
P<.001; overall rates: 29.0% vs 14.9%, respectively;
2 = 88.1;
P<.001). For similar degrees of organ dysfunction,
patients who had a transfusion had a higher mortality rate.
For matched patients in the propensity analysis, the 28-day
mortality was 22.7% among patients with transfusions and 17.1%
among those without (
P = .02); the Kaplan-Meier log-rank test
confirmed this difference.
Conclusions This multicenter observational study reveals
the common occurrence of anemia and the large use of blood transfusion
in critically ill patients. Additionally, this epidemiologic
study provides evidence of an association between transfusions
and diminished organ function as well as between transfusions
and mortality.
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