title: Red blood cell transfusions and nosocomial infections in critically ill patients.
abstract: OBJECTIVE
  A previous retrospective evaluation of Project Impact data demonstrated an association between red blood cell transfusions, nosocomial infections, and poorer outcomes in critically ill patients, independent of survival probability or patient age. The objective of this study was to determine whether transfused patients, independent of survival probability based on Mortality Prediction Model scores, have higher nosocomial infection rates, longer intensive care unit and hospital lengths of stay, and higher mortality rates than nontransfused patients.
  
  
  METHODS
  Prospective, observational, cohort study.
  
  
  METHODS
  A single-center, mixed medical/surgical, closed intensive care unit.
  
  
  METHODS
  : Adults admitted to St. John's Mercy Medical Center between August 2001 and June 2003 (n = 2,085) were enrolled using Project Impact software. Both nonoperative and postoperative populations were represented, and transfusion decisions were made independently of patient study inclusion. Patients whose nosocomial infection was diagnosed before transfusion were counted as nontransfused.
  
  
  METHODS
  : None.
  
  
  RESULTS
  Nosocomial infections, mortality rates, and intensive care unit and hospital length of stay were the main outcome measures. Of the 2,085 patients enrolled, 21.5% received red blood cell transfusions. The posttransfusion nosocomial infection rate was 14.3% in 428 evaluable patients, significantly higher than that observed in nontransfused patients (5.8%; p < .0001, chi-square). In a multivariate analysis controlling for patient age, maximum storage age of red blood cells, and number of red blood cell transfusions, only the number of transfusions was independently associated with nosocomial infection (odds ratio 1.097; 95% confidence interval 1.028-1.171; p = .005). When corrected for survival probability, the risk of nosocomial infection associated with red blood cell transfusions remained statistically significant (p < .0001). Leukoreduction tended to reduce the nosocomial infection rate but not significantly. Mortality and length of stay (intensive care unit and hospital) were significantly higher in transfused patients, even when corrected for illness severity.
  
  
  CONCLUSIONS
  Red blood cell transfusions should be used sparingly, bearing in mind the potential risks of infection and poor outcomes in critically ill patients.
authors.affiliation: St. John's Mercy Medical Center, St. Louis University, MO, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Taylor
authors.forename: Jacklyn
authors.initials: J
authors.lastname: O'Brien
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Trottier
authors.forename: Lisa
authors.initials: L
authors.lastname: Manganaro
authors.forename: Margaret
authors.initials: M
authors.lastname: Cytron
authors.forename: Mary F
authors.initials: MF
authors.lastname: Lesko
authors.forename: Kimberly
authors.initials: K
authors.lastname: Arnzen
authors.forename: Carla
authors.initials: C
authors.lastname: Cappadoro
authors.forename: Min
authors.initials: M
authors.lastname: Fu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Plisco
authors.forename: Farid G
authors.initials: FG
authors.lastname: Sadaka
authors.forename: Christopher
authors.initials: C
authors.lastname: Veremakis
mesh_terms: D016638:Critical Illness; D003428:Cross Infection / Q000209:etiology* / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D007937:Leukapheresis; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D011446:Prospective Studies