title: Morbidity and Mortality after High-dose Transfusion.
abstract: BACKGROUND
  It is well recognized that increased transfusion volumes are associated with increased morbidity and mortality, but dose-response relations between high- and very-high-dose transfusion and clinical outcomes have not been described previously. In this study, the authors assessed (1) the dose-response relation over a wide range of transfusion volumes for morbidity and mortality and (2) other clinical predictors of adverse outcomes.
  
  
  METHODS
  The authors retrospectively analyzed electronic medical records for 272,592 medical and surgical patients (excluding those with hematologic malignancies), 3,523 of whom received transfusion (10 or greater erythrocyte units throughout the hospital stay), to create dose-response curves for transfusion volumes and in-hospital morbidity and mortality. Prehospital comorbidities were assessed in a risk-adjusted manner to identify the correlation with clinical outcomes.
  
  
  RESULTS
  For patients receiving high- or very-high-dose transfusion, infections and thrombotic events were four to five times more prevalent than renal, respiratory, and ischemic events. Mortality increased linearly over the entire dose range, with a 10% increase for each 10 units of erythrocytes transfused and 50% mortality after 50 erythrocyte units. Independent predictors of mortality were transfusion dose (odds ratio [OR], 1.037; 95% CI, 1.029 to 1.044), the Charlson comorbidity index (OR, 1.209; 95% CI, 1.141 to 1.276), and a history of congestive heart failure (OR, 1.482; 95% CI, 1.062 to 2.063).
  
  
  CONCLUSIONS
  Patients receiving high- or very-high-dose transfusion are at especially high risk for hospital-acquired infections and thrombotic events. Mortality increased linearly over the entire dose range and exceeded 50% after 50 erythrocyte units.
authors.affiliation: From the Department of Anesthesiology and Critical Care Medicine (D.J.J., A.V.S., V.M.B., S.P., J.O.W., S.M.F.) and Department of Pathology (P.M.N., T.G.), The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Johnson
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Scott
authors.forename: Viachaslau M
authors.initials: VM
authors.lastname: Barodka
authors.forename: Sunhee
authors.initials: S
authors.lastname: Park
authors.forename: Jack O
authors.initials: JO
authors.lastname: Wasey
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.forename: Tom
authors.initials: T
authors.lastname: Gniadek
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods* / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome