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Prospective Inverse Probability of Treatment-Weighting Analysis of the Clinical Outcome of Red Blood Cell Transfusion
Singanamalla Bhanudeep1, Ramachandran Rameshkumar2, Muthu Chidambaram1
1Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
Insights
Red blood cell (RBC) transfusions in critically ill children were linked to a 53% increased risk of 28-day mortality. This study highlights potential adverse outcomes associated with RBC transfusions in pediatric intensive care units.
Area of Science:
- Pediatric Critical Care Medicine
- Transfusion Medicine
- Clinical Outcomes Research
Background:
- Red blood cell (RBC) transfusions are common in critically ill children.
- The clinical outcomes associated with RBC transfusion practices in this population require further investigation.
Purpose of the Study:
- To investigate the association between RBC transfusion and clinical outcomes in critically ill children.
- To analyze the impact of RBC transfusions on mortality and morbidity in a pediatric intensive care unit (PICU) setting.
Main Methods:
- Prospective cohort study including 1014 children (1 mo to 12 y) admitted to a tertiary care PICU.
- Used Inverse Probability of Treatment Weighting (IPTW) with propensity score analysis to compare transfused and nontransfused groups.
- Excluded patients with hematological malignancies, on immunosuppressants, or with prior/repeated transfusions.
Main Results:
- RBC transfusion was associated with a 53% higher risk of 28-day all-cause mortality (HR 1.53, p=0.001).
- Transfused patients had a higher incidence of new-onset organ dysfunction (3.8% vs 1.3%, HR 3.0, p=0.005).
- Increased risk of extended PICU (HR 1.16, p=0.005) and hospital stay (HR 1.21, p=0.001) was observed in transfused children.
Conclusions:
- Red blood cell transfusion is independently associated with increased 28-day mortality in critically ill children.
- RBC transfusion is linked to higher rates of morbidity, including organ dysfunction and prolonged hospital stays, in this vulnerable pediatric population.
Objective:
To study the clinical outcomes of red blood cell (RBC) transfusion practices in critically ill children.
Method:
This prospective cohort study was conducted in a tertiary care pediatric intensive care unit (PICU) from March-2015 to January-2018. Inverse probability of treatment weighting (IPTW) using propensity score analysis was used. Children aged 1 mo to 12 y admitted to the PICU were screened. Patients were classified into 'transfused' and 'nontransfused', based on whether they received a transfusion or not. Patients with hematological malignancies, or immunosuppressant drugs, or those who received repeated transfusions, or received transfusion before admission, or died within 24 h were excluded. The primary outcome was all-cause 28 d mortality. Secondary outcomes were new-onset organ dysfunction, mechanical ventilation duration, and length of PICU and hospital stay.
Results:
A total of 1014 patients [transfused = 277; nontransfused = 737) were included. In IPTW analysis, the risk of all-cause 28 d mortality was 53% higher in transfused than nontransfused patients [hazard ratio = 1.53, 95% CI: 1.18-1.98, p = 0.001 by Log-rank test]. Organ dysfunction was higher in transfused than nontransfused patients [3.8% vs. 1.3%, hazard ratio = 3.0, 95% CI: 1.40-6.48, p = 0.005]. The risk of staying in the mechanical ventilation was similar in both groups [hazard ratio = 1.03, 95% CI: 0.86-1.23, p = 0.756]. The risk of extended stay in the PICU and hospital was 16% and 21% higher in transfused than nontransfused patients [hazard ratio = 1.16, 95% CI: 1.03-1.30; p = 0.005; and 1.21, 95% CI: 1.08-1.36; p = 0.001], respectively.
Conclusion:
Red blood cell transfusion was independently associated with higher all-cause 28 d mortality and morbidities in critically ill children.
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