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Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: A propensity-matched analysis*

Park, Dae Won MD, PhD; Chun, Byung-Chul MD, PhD; Kwon, Soon-Sun PhD; Yoon, Young Kyung MD, PhD; Choi, Won Suk MD, PhD; Sohn, Jang Wook MD, PhD; Peck, Kyong Ran MD, PhD; Kim, Yang Soo MD, PhD; Choi, Young Hwa MD, PhD; Choi, Jun Yong MD, PhD; Kim, Sang Il MD, PhD; Eom, Joong Sik MD, PhD; Kim, Hyo Youl MD, PhD; Cheong, Hee Jin MD, PhD; Song, Young Goo MD, PhD; Choi, Hee Jung MD, PhD; Kim, June Myung MD, PhD; Kim, Min Ja MD, PhD

doi: 10.1097/CCM.0b013e3182657b75
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Objectives: To evaluate the effects of transfusions in patients with severe sepsis and septic shock on mortality.

Design: Propensity-matched analysis of a prospective observational database (April 2005 to February 2009).

Setting: Twenty-two medical and surgical intensive care units in 12 teaching hospitals in Korea.

Patients: One thousand fifty-four patients with community-acquired severe sepsis and septic shock.

Interventions None.

Measurements and Main 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.

From the Division of Infectious Diseases (DW, WSC), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Departments of Preventive Medicine (B-CC) and Biostatics (S-SK), Korea University College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases (YKY, JWS, MJK), Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases (KRP), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Infectious Diseases (YSK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Infectious Diseases (YHC), Ajou University School of Medicine, Suwon, Republic of Korea; Department of Internal Medicine (HJC, YGS, JMK), Yonsei University Medical College, Seoul, Republic of Korea; Department of Internal Medicine (SIK), Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine (JSE), Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea; Department of Internal Medicine (HYK), Division of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea; Division of Infectious Diseases (HJC), University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine (HJC), Ewha Womans University School of Medicine, Seoul, Republic of Korea.

*See also p. 3308.

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Supported by grant from The Korean Society of Infectious Diseases and partly supported by grant (A102065) from the Korean Health 21 R&D project, Ministry for Health, Welfare and Family Affairs, Republic of Korea.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: macropha@korea.ac.kr

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins