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Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis

Authors
 Park, Dae Won  ;  Chun, Byung-Chul  ;  Kwon, Soon-Sun  ;  Yoon, Young Kyung  ;  Choi, Won Suk  ;  Sohn, Jang Wook  ;  Peck, Kyong Ran  ;  Kim, Yang Soo  ;  Choi, Young Hwa  ;  Choi, Jun Yong  ;  Kim, Sang Il  ;  Eom, Joong Sik  ;  Kim, Hyo Youl  ;  Cheong, Hee Jin  ;  Song, Young Goo  ;  Choi, Hee Jung  ;  Kim, June Myung  ;  Kim, Min Ja 
Citation
 CRITICAL CARE MEDICINE, Vol.40(12) : 3140-3145, 2012 
Journal Title
CRITICAL CARE MEDICINE
ISSN
 0090-3493 
Issue Date
2012
MeSH
Aged ; Community-Acquired Infections/mortality ; Confidence Intervals ; Erythrocyte Transfusion/mortality* ; Female ; Hospitals, Teaching ; Humans ; Intensive Care Units* ; Male ; Middle Aged ; Odds Ratio ; Propensity Score ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Assessment ; Shock, Septic/mortality*
Keywords
blood transfusion ; mortality ; septic shock ; severe sepsis
Abstract
OBJECTIVES: To evaluate the effects of transfusions in patients with severe sepsis and septic shock on mortality.

DESIGN: Propensity-matched analysis of a prospective observational database (April 2005 to February 2009).

SETTING: Twenty-two medical and surgical intensive care units in 12 teaching hospitals in Korea.

PATIENTS: One thousand fifty-four patients with community-acquired severe sepsis and septic shock.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Of the 1,054 patients, 407 (38.6%) received a blood transfusion. The mean pretransfusion hemoglobin level was 7.7 ± 1.2 g/dL. Transfused patients had higher 28-day and in-hospital mortality rates (32.7% vs. 17.3%; p < .001, 41.3% vs. 20.3%; p < .001, respectively) and a longer duration of hospital stay (21 [interquartile range, 10-35] vs. 13 [interquartile range, 8-24] days; p < .001), but were more severely ill at admission (lower systolic blood pressure, higher Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score at admission). In 152 pairs matched according to the propensity score depending on patient transfusion status, transfused patients had a lower risk of 7-day (9.2% vs. 27.0%; p < .001), 28-day (24.3% vs. 38.8%; p = .007), and in-hospital mortality rates (31.6% vs. 42.8%; p = .044). After adjusting for blood transfusion as a time-dependent variable in multivariable analysis, blood transfusion was independently associated with lower risk of 7-day (hazard ratio 0.42, 95% confidence interval 0.19-0.50, p = .026), 28-day (hazard ratio 0.43, 95% confidence interval 0.29-0.62, p < .001), and in-hospital mortality (hazard ratio 0.51, 95% confidence interval 0.39-0.69, p < .001).

CONCLUSIONS: In this observational study of patients with community-acquired severe sepsis and septic shock, red blood cell transfusions were associated with lower risk of mortality.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00003246-201212000-00004&LSLINK=80&D=ovft
DOI
22975891
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, June Myung(김준명)
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90080
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