title: Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy.
abstract: OBJECTIVE
  Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy.
  
  
  METHODS
  Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital.
  
  
  METHODS
  All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovah's Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl.
  
  
  RESULTS
  The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively.
  
  
  CONCLUSIONS
  In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.
authors.affiliation: Hospital do Servidor Público Estadual, São Paulo, Brazil. joao.s@globo.com
authors.forename: João Manoel da
authors.initials: JM
authors.lastname: Silva Junior
authors.forename: Ederlon
authors.initials: E
authors.lastname: Rezende
authors.forename: Cristina Prada
authors.initials: CP
authors.lastname: Amendola
authors.forename: Rafael
authors.initials: R
authors.lastname: Tomita
authors.forename: Daniele
authors.initials: D
authors.lastname: Torres
authors.forename: Maria Tereza
authors.initials: MT
authors.lastname: Ferrari
authors.forename: Diogo Oliveira
authors.initials: DO
authors.lastname: Toledo
authors.forename: Amanda Maria Ribas Rosa
authors.initials: AM
authors.lastname: Oliveira
authors.forename: Juliana Andreia
authors.initials: JA
authors.lastname: Marques
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000628:therapy*; D001803:Blood Transfusion / Q000379:methods; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D003657:Decision Making / Q000502:physiology; D004812:Epidemiologic Methods; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology*; D012016:Reference Values; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins