Red blood cell transfusion risk factors and outcomes in burn patients: A retrospective cohort study

Patients with burn injuries often develop a state of multifactorial anemia, resulting in significant red blood cell transfusion, which may cause adverse effects. We aimed to identify clinical factors associated with red blood cell transfusion and to assess the relationship between red blood cell transfusion and outcomes in critically ill burn patients.

We conducted a retrospective single-center study at the Burn Intensive Care Unit of Saint Louis Hospital in Paris from 2012 to 2022, approved by the local ethics committee. The primary outcome was the occurrence of red blood cell transfusion. Secondary outcomes included 28- and 90-day in-hospital mortality and acute kidney injury.

Of the 1704 patients included in the study, 564 (33 %) received red blood cell transfusions. Age, extent of burn, burn depth, length of stay in the Burn Intensive Care Unit, presence of anemia on admission, and timing of surgical procedures were associated with the likelihood of red blood cell transfusion. Red blood cell transfusion was associated with an increased risk of acute kidney injury (OR 4.53 [3.03; 6.80], p < 0.001) but with a decreased risk of 28-day mortality (OR 0.43 [0.20, 0.89], p = 0.026). However, after patients who died within the first 48 h of hospitalization were excluded, red blood cell transfusion was no longer significantly associated with 28-day mortality (OR 0.9 [0.43, 1.90], p = 0.78). Red blood cell transfusion was not associated with 90-day mortality (OR 0.53 [0.25, 1.08], p = 0.083). We identify three clusters associated with different incidence of red blood cell transfusion (9.8 %, 67.8 % and 89 % in cluster 1, 0 and 2 respectively).

Red blood cell transfusion is closely related to burn severity and is associated with an increased risk of acute kidney injury. Future controlled, randomized trials are needed to determine whether restrictive transfusion strategies could reduce the risk of acute kidney injury in critically ill burn patients.