Transfusion trigger in the critically ill with sepsis or septic shock: A prospective study

Area of Science:

• Critical Care Medicine
• Hematology
• Transfusion Medicine

Background:

• Current transfusion trigger practices for critically ill sepsis patients lack clarity.
• The association between hemoglobin trigger, red blood cell age, and transfusion volume with mortality requires further investigation.

Purpose of the Study:

• To evaluate the current transfusion trigger practices in critically ill sepsis patients.
• To assess the impact of hemoglobin trigger and red blood cell transfusion parameters on mortality and adverse outcomes.

Main Methods:

• A prospective study included 108 critically ill sepsis patients (18-70 years).
• Data collected included baseline demographics, clinical parameters, and transfusion details (hemoglobin trigger, RBC age, units transfused).
• Outcomes measured were 28 and 90-day mortality, mechanical ventilation duration, vasopressor therapy, ICU/hospital stay, and renal replacement therapy.

Main Results:

• The median transfusion trigger was 6.9 g/dL.
• Predictors of 28-day mortality included APACHE II score, cumulative fluid balance, and admission platelet count.
• For 90-day mortality, predictors were APACHE II score, cumulative fluid balance, and the transfusion trigger (aOR: 3 [1.07, 8.34], P=0.035).

Conclusions:

• In critically ill sepsis patients, the current practice involves a transfusion trigger below 7 g/dL.
• This transfusion trigger level did not significantly affect 28-day mortality in the study population.