Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-06-12

AUTHORS

Adrien Mirouse, Matthieu Resche-Rigon, Virginie Lemiale, Djamel Mokart, Achille Kouatchet, Julien Mayaux, François Vincent, Martine Nyunga, Fabrice Bruneel, Antoine Rabbat, Christine Lebert, Pierre Perez, Anne Renault, Anne-Pascale Meert, Dominique Benoit, Rebecca Hamidfar, Mercé Jourdain, Michaël Darmon, Elie Azoulay, Frédéric Pène, on behalf of the Groupe de Recherche sur la Réanimation Respiratoire en Onco-Hématologie (Grrr-OH)

ABSTRACT

BackgroundIndications 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.MethodsWe 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.ResultsAmong 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.ConclusionsRBC 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. More... »

PAGES

62

Journal

TITLE

Annals of Intensive Care

ISSUE

1

VOLUME

7

Author Affiliations

  • Réanimation médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
  • Département de biostatistiques, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
  • Réanimation médicale, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Paris, France
  • Département d’anesthésie-réanimation, Institut Paoli-Calmettes, Marseille, France
  • Réanimation médicale et médecine hyperbare, CHU d’Angers, Angers, France
  • Réanimation médicale, Hôpital de la Pitié-Salpêtrière, AP-HP and Université Pierre et Marie Curie, Paris, France
  • Réanimation polyvalente, Centre Hospitalier Intercommunal, Montfermeil, France
  • Centre Hospitalier de Roubaix, Roubaix, France
  • Réanimation polyvalente, Hôpital André Mignot, Le Chesnay, France
  • Unité de soins intensifs respiratoires, Hôpital Cochin, AP-HP and Université Paris Descartes, Paris, France
  • Réanimation polyvalente, Centre Hospitalier Départemental, La Roche-sur-Yon, France
  • Réanimation médicale, Hôpital Brabois, Nancy, France
  • Réanimation médicale, Centre Hospitalier de Brest, Brest, France
  • Service des soins intensifs et urgences oncologiques, Institut Jules Bordet, Brussels, Belgium
  • Ghent University Hospital, Ghent, Belgium
  • Réanimation médicale, CHU Grenoble-Alpes, Grenoble, France
  • Université de Lille and Réanimation Polyvalente, CHU de Lille, Lille, France
  • Réanimation médicale, Centre Hospitalier de Saint-Etienne, Saint-Etienne, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s13613-017-0292-3

    DOI

    http://dx.doi.org/10.1186/s13613-017-0292-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1085981858

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28608137


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