Retrospective Analysis: Exploring Transfusion Thresholds' Impact on Patients with Sepsis and Renal Failure

Sepsis with renal failure is a common condition in intensive care units (ICUs) and is associated with poor prognosis. A unified consensus on the optimal transfusion hemoglobin concentration threshold is needed to improve outcomes. This study investigated the effects of different transfusion thresholds during hospitalization on the prognosis of patients with sepsis and renal failure.

A total of 2,972 patients were included in this study. By using the Medical Information Mart for Intensive Care (MIMIC-IV) database, data from patients with sepsis and renal failure were screened and divided into a low-threshold group (Hb ≤ 7 g/dL) and a high-threshold group (Hb > 7 g/dL) based on the average hemoglobin (Hb) level 24 hours before transfusion. Univariate and multivariate Cox regression analyses and inverse probability weighting were used to compare in-hospital and ICU mortality rates between the two groups. Additionally, 30-day, 60-day, and 90-day survival rates, length of hospital stay, and ICU stay duration were evaluated.

Statistically significant differences in baseline characteristics were observed between the two groups. After propensity score matching to eliminate baseline characteristic differences, it was found that among the Cau¬casian population a higher transfusion threshold significantly reduced the risk of in-hospital mortality (HR, 0.774; 95% CI: 0.613 - 0.978, p < 0.05).

For patients with sepsis and renal failure, transfusion thresholds should be determined by considering the patient's race to achieve individualized transfusion strategies.