Risk factors for post-ICU red blood cell transfusion: a prospective study.
BACKGROUND
Factors predictive of the need for red blood cell (RBC) transfusion in the intensive care unit (ICU) have been identified, but risk factors for transfusion after ICU discharge are unknown. This study aims identifies risk factors for RBC transfusion after discharge from the ICU.


METHODS
A prospective, monocentric observational study was conducted over a 6-month period in a 24-bed medical ICU in a French university hospital. Between June and December 2003, 550 critically ill patients were consecutively enrolled in the study.


RESULTS
A total of 428 patients survived after treatment in the ICU; 47 (11% of the survivors, 8.5% of the whole population) required RBC transfusion within 7 days after ICU discharge. Admission for sepsis (odds ratio [OR] 341.60, 95% confidence interval [CI] 20.35-5734.51), presence of an underlying malignancy (OR 32.6, 95%CI 3.8-280.1), female sex (OR 5.4, 95% CI 1.2-24.9), Logistic Organ Dysfunction score at ICU discharge (OR 1.45, 95% CI 1.1-1.9) and age (OR 1.06, 95% CI 1.02-1.12) were independently associated with RBC transfusion after ICU stay. Haemoglobin level at discharge predicted the need for delayed RBC transfusion. Use of vasopressors (OR 0.01, 95%CI 0.001-0.17) and haemoglobin level at discharge from the ICU (OR 0.02, 95% CI 0.007-0.09; P < 0.001) were strong independent predictors of transfusion of RBC 1 week after ICU discharge.


CONCLUSIONS
Sepsis, underlying conditions, unresolved organ failures and haemoglobin level at discharge were related to an increased risk for RBC transfusion after ICU stay. We suggest that strategies to prevent transfusion should focus on homogeneous subgroups of patients and take into account post-ICU needs for RBC transfusion.
Marque
Sophie
S
Medical Intensive Care Unit, Cochin Hospital, rue du Faubourg Saint-Jacques, F-75679 Paris Cedex 14, France.
Cariou
Alain
A
Chiche
Jean-Daniel
JD
Mallet
Vincent Olivier
VO
Pene
Frédéric
F
Mira
Jean-Paul
JP
Dhainaut
Jean-François
JF
Claessens
Yann-Erick
YE
D000328:Adult; D000368:Aged; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000628:therapy; D015996:Survival Rate