Critical Care: Critical Care - ICU Management |

Red Cell Transfusion and Mortality of MICU Patients Receiving Continuous Renal Replacement Therapy FREE TO VIEW

William Fuller, MD; Evan Cassity; Andrew Kelly; Radmila Choate; Anna Kalema; Ashley Montgomery-Yates; Aleksandra Wieleczko; David Mannino; Peter Morris
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Univeristy of Kentucky, Lexington, KY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):223A. doi:10.1016/j.chest.2016.08.236
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SESSION TITLE: Critical Care - ICU Management

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Kidney replacement therapy in the ICU is associated with an increased risk of death. This study’s hypothesis was that ICU patients who received continuous renal replacement therapy (CRRT) had exposure to more red cell transfusions than those ICU patients whose ICU course did not require CRRT.

METHODS: We reviewed hospitalization data from a university hospital Medical Intensive Care Unit service (MICU) to examine patient outcomes. We examined the number of packed red blood cells (PRBCs) transfusions for patients who required CRRT and did not require CRRT. The results for categorical variables were reported by proportions, and continuous variables as mean (SD), and KM median (95% CI). Values between the groups were compared using two sample t-tests.

RESULTS: From July, 2013 through September, 2015 there were 4152 hospitalizations where patients required ≥1 ICU days on the MICU service. The percentage of hospitalizations in which MICU patients received MV, pressor agents for Shock, or CRRT were 78.5%, 50.9%, and 4.2% respectively. The number of hospitalizations with patients requiring MV, pressor agents for Shock, and CRRT were 165 (4%). ICU mortality was 22.8% for any MV pt, 20.8% for any shock pt, and 50.5% for any CRRT pt. Hospital mortality for MV-shock-CRRT was 59.4% vs MV-shock-No CRRT 46.4%. The mean number of PRBC transfusions for MV-Shock-CRRT pts was 1.8 units vs 0.9 units in pts with MV and pressor agents for Shock, but no CRRT (p< 0.001). The ICU length of stay (LOS) for MV, Shock, CRRT patients was 22.5d, whereas the MV, Shock, No CRRT patients’ ICU LOS was 12d.

CONCLUSIONS: Of MICU hospitalizations with MV, pressor agents for shock & CRRT, RBC Transfusions were greater than in MICU hospitalizations with MV, pressors for Shock but no CRRT. MV, pressor agents for Shock & CRRT patients demonstrated a higher mortality than patients who required MV, pressor agents for Shock, but not CRRT.

CLINICAL IMPLICATIONS: Further studies may be necessary to determine whether the greater exposure to RBC transfusions within the MV, Shock, CRRT population is preventable or may be attributable to other factors leading to a longer ICU stay. A longer ICU LOS among the MV, Shock, CRRT patients could provide a greater number of days in which a RBC transfusion might be necessary. Additionally, further studies may clarify whether the increase in PRBC transfusion plays a direct mechanistic role contributing to a higher mortality, such as sustaining acute lung injury.

DISCLOSURE: The following authors have nothing to disclose: William Fuller, Evan Cassity, Andrew Kelly, Radmila Choate, Anna Kalema, Ashley Montgomery-Yates, Aleksandra Wieleczko, David Mannino, Peter Morris

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