RBC Transfusion Practices in Critically Ill Patients With Sepsis.

Area of Science:

• Critical Care Medicine
• Hematology
• Transfusion Medicine

Background:

• Red blood cell (RBC) transfusions are frequently administered during early sepsis resuscitation.
• Current clinical practice for RBC transfusion in sepsis may not align with existing evidence-based guidelines.

Purpose of the Study:

• To investigate real-world RBC transfusion patterns in early sepsis resuscitation.
• To determine the association between early RBC transfusions and 60-day mortality in sepsis patients.

Main Methods:

• Secondary analysis of a prospective, multicenter observational cohort (Korean Sepsis Alliance) including 2613 adult ICU patients with sepsis.
• Patients were categorized into transfused and non-transfused groups based on RBC transfusion within the first three ICU days.
• Propensity score matching was used to control for confounding factors.

Main Results:

• 45.3% of sepsis patients received RBC transfusions during early resuscitation, often with hemoglobin levels above 10 g/dL.
• RBC transfusion was associated with clinical factors beyond hemoglobin, including higher illness severity scores and organ dysfunction.
• In propensity score-matched analysis, no overall difference in 60-day mortality was observed. However, a significant interaction indicated higher mortality with transfusions at hemoglobin ≥ 10 g/dL and a trend toward decreased mortality at < 10 g/dL.

Conclusions:

• RBC transfusions are prevalent in critically ill sepsis patients, indicating a discrepancy with guideline recommendations.
• While overall mortality was not affected, a hemoglobin threshold of 10 g/dL is critical.
• Transfusions may be beneficial below 10 g/dL but should be avoided when hemoglobin levels are 10 g/dL or higher to prevent potential harm.