title: Recombinant human erythropoietin therapy in critically ill patients: a dose-response study [ISRCTN48523317].
abstract: BACKGROUND
  The aim of this study was to assess the efficacy of two dosing schedules of recombinant human erythropoietin (rHuEPO) in increasing haematocrit (Hct) and haemoglobin (Hb) and reducing exposure to allogeneic red blood cell (RBC) transfusion in critically ill patients.
  
  
  METHODS
  This was a prospective, randomized, multicentre trial. A total of 13 intensive care units participated, and a total of 148 patients who met eligibility criteria were enrolled. Patients were randomly assigned to receive intravenous iron saccharate alone (control group), intravenous iron saccharate and subcutaneous rHuEPO 40,000 units once per week (group A), or intravenous iron saccharate and subcutaneous rHuEPO 40,000 units three times per week (group B). rHuEPO was given for a minimum of 2 weeks or until discharge from the intensive care unit or death. The maximum duration of therapy was 3 weeks.
  
  
  RESULTS
  The cumulative number of RBC units transfused, the average numbers of RBC units transfused per patient and per transfused patient, the average volume of RBCs transfused per day, and the percentage of transfused patients were significantly higher in the control group than in groups A and B. No significant difference was observed between group A and B. The mean increases in Hct and Hb from baseline to final measurement were significantly greater in group B than in the control group. The mean increase in Hct was significantly greater in group B than in group A. The mean increase in Hct in group A was significantly greater than that in control individuals, whereas the mean increase in Hb did not differ significantly between the control group and group A.
  
  
  CONCLUSIONS
  Administration of rHuEPO to critically ill patients significantly reduced the need for RBC transfusion. The magnitude of the reduction did not differ between the two dosing schedules, although there was a dose response for Hct and Hb to rHuEPO in these patients.
authors.affiliation: Department of Intensive Care Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece. georgop@med.uoc.gr
authors.forename: Dimitris
authors.initials: D
authors.lastname: Georgopoulos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Matamis
authors.forename: Christina
authors.initials: C
authors.lastname: Routsi
authors.forename: Argiris
authors.initials: A
authors.lastname: Michalopoulos
authors.forename: Nina
authors.initials: N
authors.lastname: Maggina
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Zakynthinos
authors.forename: George
authors.initials: G
authors.lastname: Nakos
authors.forename: George
authors.initials: G
authors.lastname: Thomopoulos
authors.forename: Kostas
authors.initials: K
authors.lastname: Mandragos
authors.forename: Alice
authors.initials: A
authors.lastname: Maniatis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D004812:Epidemiologic Methods; D004912:Erythrocytes / Q000187:drug effects*; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006454:Hemoglobins / Q000187:drug effects*; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron