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Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies
BACKGROUND: Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies. METHODS:...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468360/ https://www.ncbi.nlm.nih.gov/pubmed/28608137 http://dx.doi.org/10.1186/s13613-017-0292-3 |
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author | Mirouse, Adrien Resche-Rigon, Matthieu Lemiale, Virginie Mokart, Djamel Kouatchet, Achille Mayaux, Julien Vincent, François Nyunga, Martine Bruneel, Fabrice Rabbat, Antoine Lebert, Christine Perez, Pierre Renault, Anne Meert, Anne-Pascale Benoit, Dominique Hamidfar, Rebecca Jourdain, Mercé Darmon, Michaël Azoulay, Elie Pène, Frédéric |
author_facet | Mirouse, Adrien Resche-Rigon, Matthieu Lemiale, Virginie Mokart, Djamel Kouatchet, Achille Mayaux, Julien Vincent, François Nyunga, Martine Bruneel, Fabrice Rabbat, Antoine Lebert, Christine Perez, Pierre Renault, Anne Meert, Anne-Pascale Benoit, Dominique Hamidfar, Rebecca Jourdain, Mercé Darmon, Michaël Azoulay, Elie Pène, Frédéric |
author_sort | Mirouse, Adrien |
collection | PubMed |
description | BACKGROUND: Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies. METHODS: We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010–2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation. RESULTS: Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1–3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03–2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05–2.57], p = 0.03) analysis. CONCLUSIONS: RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13613-017-0292-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5468360 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-54683602017-06-26 Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies Mirouse, Adrien Resche-Rigon, Matthieu Lemiale, Virginie Mokart, Djamel Kouatchet, Achille Mayaux, Julien Vincent, François Nyunga, Martine Bruneel, Fabrice Rabbat, Antoine Lebert, Christine Perez, Pierre Renault, Anne Meert, Anne-Pascale Benoit, Dominique Hamidfar, Rebecca Jourdain, Mercé Darmon, Michaël Azoulay, Elie Pène, Frédéric Ann Intensive Care Research BACKGROUND: Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies. METHODS: We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010–2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation. RESULTS: Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1–3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03–2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05–2.57], p = 0.03) analysis. CONCLUSIONS: RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13613-017-0292-3) contains supplementary material, which is available to authorized users. Springer International Publishing 2017-06-12 /pmc/articles/PMC5468360/ /pubmed/28608137 http://dx.doi.org/10.1186/s13613-017-0292-3 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research Mirouse, Adrien Resche-Rigon, Matthieu Lemiale, Virginie Mokart, Djamel Kouatchet, Achille Mayaux, Julien Vincent, François Nyunga, Martine Bruneel, Fabrice Rabbat, Antoine Lebert, Christine Perez, Pierre Renault, Anne Meert, Anne-Pascale Benoit, Dominique Hamidfar, Rebecca Jourdain, Mercé Darmon, Michaël Azoulay, Elie Pène, Frédéric Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies |
title | Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies |
title_full | Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies |
title_fullStr | Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies |
title_full_unstemmed | Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies |
title_short | Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies |
title_sort | red blood cell transfusion in the resuscitation of septic patients with hematological malignancies |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468360/ https://www.ncbi.nlm.nih.gov/pubmed/28608137 http://dx.doi.org/10.1186/s13613-017-0292-3 |
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