Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock

Abstract

Introduction To determine the association between red blood cell (RBC) transfusion and outcomes in patients with acute lung injury (ALI), sepsis, and shock.

Methods We performed a secondary analysis of new-onset ALI patients enrolled in the ARDSNet Fluid and Catheter Treatment Trial (2000-2005) who had a documented ALI risk factor of sepsis or pneumonia and met shock criteria (mean arterial pressure (MAP) < 60 mm Hg or vasopressor use) within 24 hours of randomization. Using multivariable logistic regression, we examined the association between RBC transfusion and 28-day mortality after adjustment for age, sex, race, randomization arm, and APACHE III score. Secondary endpoints included 90-day mortality and ventilator free days (VFDs). Finally, we examined these endpoints among the subset of subjects meeting prespecified transfusion criteria defined by four simultaneous indicators: hemoglobin < 10.2 g/dL, central or mixed venous oxygen saturation < 70%, central venous pressure >= 8 mm Hg, MAP >= 65 mm Hg, and vasopressor use.

Results We identified 285 subjects with ALI, sepsis, shock and transfusion data. Of these, 85 also met the above prespecified transfusion criteria. Fifty-three (19%) of the 285 subjects with shock and 20 (24%) of the subset meeting transfusion criteria received RBC transfusion within 24 hours of randomization. We found no independent association between RBC transfusion and 28-day mortality (odds ratio = 1.49, 95% CI: 0.77, 2.90, P=0.23) or VFDs (mean difference = -0.35, 95% CI: -4.03, 3.32 P=0.85). Likewise, 90-day mortality and VFDs did not differ by transfusion status. Among the subset meeting transfusion criteria, we found no independent association between transfusion and mortality or VFDs.

Conclusions In patients with new-onset ALI, sepsis, and shock, we found no independent association between RBC transfusion and mortality or VFDs. Physiologic criteria did not identify patients more likely to be transfused or to benefit from transfusion.