Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level:...

Area of Science:

• Critical Care Medicine
• Hematology

Background:

• Limited data exists on real-world red blood cell (RBC) transfusion practices in septic shock patients.
• The efficacy of RBC transfusion in septic shock with elevated lactate levels remains uncertain.

Purpose of the Study:

• To investigate RBC transfusion patterns in septic shock.
• To evaluate lactate as a potential biomarker for guiding RBC transfusion decisions.

Main Methods:

• Observational study using a prospective, multicenter registry of septic shock patients (November 2015–December 2022).
• Recorded initial hemoglobin (Hb) and RBC transfusion status within six hours of emergency department arrival.
• Analyzed in-hospital mortality using multivariable logistic regression, stratified by Hb and lactate levels.

Main Results:

• 8,711 patients were included; 10.1% received RBC transfusions, often above restrictive thresholds (57.7% at Hb ≥ 7 g/dL).
• In patients with Hb ≥ 9.0 g/dL, transfusion was linked to higher mortality (aOR, 1.99; 95% CI, 1.34-2.93).
• No significant association between RBC transfusion and mortality was found in Hb < 7.0 g/dL or Hb 7.0-8.9 g/dL groups.

Conclusions:

• RBC transfusions are frequently given in septic shock, sometimes exceeding guidelines, especially with elevated lactate.
• Transfusion in septic shock patients with elevated lactate did not demonstrate improved in-hospital mortality.