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Blood Transfusion Utilization in Patients with Severe Coronavirus Disease 2019 in the Republic of Korea: A Nationwide
Young Joo Oh1, Jeong Yeon Kim1,2, Jin Woong Suh1,2
1Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea.
Insights
Severe COVID-19 patients requiring transfusion had higher mortality. Risk factors included kidney disease and mechanical ventilation, while cerebrovascular disease was protective. Understanding these patterns aids resource management.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic disrupted blood supply and demand dynamics.
- Severe COVID-19 cases present unique challenges for transfusion medicine.
- Understanding transfusion needs in severe COVID-19 is crucial for patient outcomes and resource allocation.
Purpose of the Study:
- To investigate blood product prescription patterns in severe COVID-19 patients.
- To identify risk factors associated with blood transfusion in this population.
- To analyze the impact of transfusion on 90-day mortality in severe COVID-19.
Main Methods:
- Nationwide population-based cohort study in the Republic of Korea (January-December 2021).
- Included adult patients (≥19 years) with severe COVID-19 requiring oxygen therapy.
- Data sourced from the National Health Insurance Service database.
Main Results:
- A total of 41,203 severe COVID-19 patients were analyzed; 7.11% received transfusions.
- Transfusion was independently associated with increased 90-day mortality (HR: 1.36, p < 0.001).
- Risk factors for transfusion included chronic kidney disease, surgery, renal replacement therapy, mechanical ventilation, and ECMO. Protective factors included cerebrovascular disease, high Charlson Comorbidity Index, ICU admission, and anticoagulation.
Conclusions:
- This study characterizes blood transfusion patterns in severe COVID-19.
- Key risk and protective factors for transfusion were identified.
- Findings can inform optimized medical resource stockpiling for pandemic preparedness.
Abstract:
Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected both supply and demand for blood transfusion. This study aimed to investigate the prescription patterns of blood products and identify the risk factors for blood transfusion in patients with severe COVID-19. Methods: This nationwide population-based cohort study was performed in the Republic of Korea between January 2021 and December 2021. Adult patients (≥19 years) with severe COVID-19 who received oxygen therapy were examined. Data were obtained from the National Health Insurance Service database. Results: During the study period, 41,203 patients developed severe COVID-19. The overall transfusion rate was 7.11%, with 14,477 units of packed red blood cells, 4501 units of fresh frozen plasma, 20,532 units of platelet concentrates, and 1875 units of cryoprecipitate. Blood transfusion was independently associated with 90-day mortality (hazard ratio: 1.36, 95% confidence interval: 1.21-1.53, p < 0.001). Multivariate logistic regression analysis identified underlying chronic kidney disease; exposure to surgery, thrombolysis, or thrombectomy; renal replacement therapy; mechanical ventilation; and extracorporeal membrane oxygenation as significant risk factors for blood transfusion in patients with severe COVID-19. Conversely, underlying cerebrovascular diseases, a Charlson Comorbidity Index score of ≥6, admission to intensive care units, and anticoagulant use were identified as protective factors. Conclusions: This study provides an overview of blood transfusion patterns in patients with severe COVID-19. Understanding these patterns may help optimize the stockpiling of medical resources.
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