PURPOSE: Despite the risks of packed red blood cell (pRBC) transfusions, critically ill patients receive many blood transfusions.1 This study aims to identify the prognostic factors associated with the likelihood of receiving pRBC transfusions among patients admitted to the intensive care unit (ICU), coronary care unit (CCU), and intermediate ICU.
METHODS: A retrospective cohort analysis of adult patients admitted to an ICU or CCU from 139 hospitals was conducted from 01/01/04–05/01/05. Data were collected on patients ≥18 years, admitted to the ICU, CCU, and/or intermediate ICU and reported using descriptive statistics. pRBC transfusions were identified using revenue codes and procedure codes. A multivariate logistic regression model was used to identify factors associated with the likelihood of receiving a pRBC transfusion.
RESULTS: 29,331 patients received ≥1 pRBC transfusion during their ICU/CCU/intermediate ICU stay compared to 150,890 patients not receiving a pRBC transfusion. We identified many factors associated with pRBC transfusion: specifically, increased age (OR:1.007, 95%CI 1.006-1.009), mechanical ventilation (OR:1.302; 95%CI 1.252–1.355), dialysis (OR:1.976; 95%CI 1.823–2.141), acute renal failure (OR:1.202; 95%CI 1.138–1.270) congestive heart failure (OR:1.156; 95%CI 1.106–1.209), and septicemia (OR:1.079; 95%CI 1.009–1.153). The type of admission was also associated with significant differences in blood transfusions–surgical admissions (vs. medical; OR:1.786; 95%CI 1.707-1.869) and trauma admissions (vs. medical: OR:1.526; 95%CI 1.376–1.691) were associated with a higher likelihood of being transfused. Factors associated with a lower risk of transfusion included female gender (OR:0.901; 95%CI 0.870–0.933), Medicare as primary payor (OR:0.924; 95%CI 0.884–0.966), increased hemoglobin level (based on lowest recorded value; OR:0.444; 95% CI 0.439–0.450), and receiving erythropoietic factors within the ICU, CCU, and intermediate care (OR:0.257; 95%CI 0.237–0.278).
CONCLUSION: After accounting for the many factors associated with the risk of pRBC transfusion, the use of erythropoietic factors in the ICU/CCU/intermediate ICS was associated with the lowest (fourfold) likelihood of transfusions in these critically ill patients.
CLINICAL IMPLICATIONS: Early interventions in anemic critically ill patients at risk for transfusion may minimize the need for receiving pRBC transfusions.
DISCLOSURE: Samir Mody, Grant monies (from industry related sources) This study was supported by Ortho Biotech Clinical Affairs, LLC; Employee Samir Mody is an employee of Ortho Biotech Clinical Affairs, LLC.