title: Red blood cell transfusion in septic shock - clinical characteristics and outcome of unselected patients in a prospective, multicentre cohort.
abstract: BACKGROUND
  Treating anaemia with red blood cell (RBC) transfusion is frequent, but controversial, in patients with septic shock. Therefore we assessed characteristics and outcome associated with RBC transfusion in this group of high risk patients.
  
  
  METHODS
  We did a prospective cohort study at 7 general intensive care units (ICUs) including all adult patients with septic shock in a 5-month period.
  
  
  RESULTS
  Ninety-five of the 213 included patients (45%) received median 3 (interquartile range 2-5) RBC units during shock. The median pre-transfusion haemoglobin level was 8.1 (7.4-8.9) g/dl and independent of shock day and bleeding. Patients with cardiovascular disease were transfused at higher haemoglobin levels. Transfused patients had higher Simplified Acute Physiology Score (SAPS) II (56 (45-69) vs. 48 (37-61), p = 0.0005), more bleeding episodes, lower haemoglobin levels days 1 to 5, higher Sepsis-related Organ Failure Assessment (SOFA) scores (days 1 and 5), more days in shock (5 (3-10) vs. 2 (2-4), p = 0.0001), more days in ICU (10 (4-19) vs. 4 (2-8), p = 0.0001) and higher 90-day mortality (66 vs. 43%, p = 0.001). The latter association was lost after adjustment for admission category and SAPS II and SOFA-score on day 1.
  
  
  CONCLUSIONS
  The decision to transfuse patients with septic shock was likely affected by disease severity and bleeding, but haemoglobin level was the only measure that consistently differed between transfused and non-transfused patients.
authors.forename: Ragnhild G
authors.initials: RG
authors.lastname: Rosland
authors.forename: Marte U
authors.initials: MU
authors.lastname: Hagen
authors.forename: Nicolai
authors.initials: N
authors.lastname: Haase
authors.forename: Lars B
authors.initials: LB
authors.lastname: Holst
authors.forename: Morten
authors.initials: M
authors.lastname: Plambech
authors.forename: Kristian R
authors.initials: KR
authors.lastname: Madsen
authors.forename: Peter
authors.initials: P
authors.lastname: Søe-Jensen
authors.forename: Lone M
authors.initials: LM
authors.lastname: Poulsen
authors.forename: Morten
authors.initials: M
authors.lastname: Bestle
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark. anders.perner@regionh.dk.
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000628:therapy; D018806:APACHE; D017707:Erythrocyte Transfusion / Q000379:methods; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D007362:Intensive Care Units; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins