title: Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis*.
abstract: OBJECTIVE
  To evaluate the effects of transfusions in patients with severe sepsis and septic shock on mortality.
  
  
  METHODS
  Propensity-matched analysis of a prospective observational database (April 2005 to February 2009).
  
  
  METHODS
  Twenty-two medical and surgical intensive care units in 12 teaching hospitals in Korea.
  
  
  METHODS
  One thousand fifty-four patients with community-acquired severe sepsis and septic shock.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 1,054 patients, 407 (38.6%) received a blood transfusion. The mean pretransfusion hemoglobin level was 7.7 ± 1.2 g/dL. Transfused patients had higher 28-day and in-hospital mortality rates (32.7% vs. 17.3%; p < .001, 41.3% vs. 20.3%; p < .001, respectively) and a longer duration of hospital stay (21 [interquartile range, 10-35] vs. 13 [interquartile range, 8-24] days; p < .001), but were more severely ill at admission (lower systolic blood pressure, higher Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score at admission). In 152 pairs matched according to the propensity score depending on patient transfusion status, transfused patients had a lower risk of 7-day (9.2% vs. 27.0%; p < .001), 28-day (24.3% vs. 38.8%; p = .007), and in-hospital mortality rates (31.6% vs. 42.8%; p = .044). After adjusting for blood transfusion as a time-dependent variable in multivariable analysis, blood transfusion was independently associated with lower risk of 7-day (hazard ratio 0.42, 95% confidence interval 0.19-0.50, p = .026), 28-day (hazard ratio 0.43, 95% confidence interval 0.29-0.62, p < .001), and in-hospital mortality (hazard ratio 0.51, 95% confidence interval 0.39-0.69, p < .001).
  
  
  CONCLUSIONS
  In this observational study of patients with community-acquired severe sepsis and septic shock, red blood cell transfusions were associated with lower risk of mortality.
authors.affiliation: Division of Infectious Diseases, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Park
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Chun
authors.forename: Soon-Sun
authors.initials: SS
authors.lastname: Kwon
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
authors.forename: Won Suk
authors.initials: WS
authors.lastname: Choi
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Young Hwa
authors.initials: YH
authors.lastname: Choi
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Joong Sik
authors.initials: JS
authors.lastname: Eom
authors.forename: Hyo Youl
authors.initials: HY
authors.lastname: Kim
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Cheong
authors.forename: Young Goo
authors.initials: YG
authors.lastname: Song
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Choi
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000401:mortality; D016001:Confidence Intervals; D017707:Erythrocyte Transfusion / Q000401:mortality*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012772:Shock, Septic / Q000401:mortality*