The Influence Of Different RBC Transfusion Strategies On The Critically Ill Patients In ICU

Objective:The aim of the study was to find out the prevalence of anemia and red blood cell(RBC) transfusions in critically ill patients in the intensive care units(ICU).Wecompare the efficacy and adverse of the restrictive transfusion strategy with that of aliberal transfusion strategy.Methods:We enrolled214patients in the ICU from July2011to August2012. Excludedcriteria included:(1) less than18years old (2)ICU length of stay≤24Hours(3)abandoned treatment. A total of185critically ill patients were enrolled inthis study. In this retrospective review, the primary aim was to describe the prevalenceof anemia and RBC transfusion. Data collected include: patients demographics;admitting diagnosis; baseline hemoglobin level; ICU admission Acute Physiology andChronic Health EvaluationⅡ(APACHEⅡ)score; hemoglobin levels during ICUduration; RBC transfusion; ventilator hours; organ failure condition; ICU/hospitallength of stay; mortality. Patients were assigned to the restrictive red bloodtransfusion strategy group if the threshold of transfusion were below7g/dL. Amongpatients assigned to the liberal transfusion strategy group, the pretransfusion hemoglobin level was between7.0to10.0g per deciliter. using SPSS V20.0to analyzethe independents relationships between the clinic outcomes and those influencefactors. Relevant indicators with statistically significant analyzed by Ordinal logisticregression to analysis to predict death.Results:the mean admission hemoglobin level was9.5±3.1g/dL.the mean pretransfusionlevel of hemoglobin in ICU was6.9±2.0g/dL.patients with a cardiac history weretransfused at a hemoglobin level of6.4±1.4g/dL.the number of patients with atransfusion trigger below7g/dL was95,accouting51.4%.while,of those with atransfusion trigger between7to10g/dL was90,accoutiong48.6%.during the total ICUstay the mean number of RBC transfusion per patient was6.0±6.3U.increasing to7.4±7.7U when it came to patients whose ICU stay was＞7days. we foundindependent associations between the number of RBC tranfusion a patientreceived,the length of ICU stay,APACEⅡscore,organ failure condition,and mortality.There were no significant between-group differences in the rates of death (15.8%inthe liberal-strategy group vs.11.1%in the restrictive-strategy group;P=0.352).Ordinal logistic regression model was used in this study for seven variables includingthe total volume of RBC transfusion, the length of ICU/hosp stay, APACEⅡscore,organ failure condition, heart failure, heart disease history and the hemoglobin levelbefore/after RBC transfusion in ICU. In the ICU stay≤7days group, APACHEⅡscore（sOR:0.91,95%CI:0.85-0.98;P=0.006）and length of hospital stay（OR:1.08,95%CI:1.03-1.15;P=0.007）were associated with the clinic outcomes. While in the ICUlength of stay＞7days group, organ failurecondition(OR:0.42,95%CI:0.21-0.86;P=0.030),the pretranfusion hemoglobin level inICU(OR:0.94,95%CI:0.89-0.99;P=0.032) and APACHEⅡ scores(OR:0.87,95%CI:0.8-0.94;P=0.001) were the predictors of death. In both of the two groups, the totalvolume of RBC transfusion was no associated with mortality(ICU length of stay≤7 days group,OR:0.9;95%CI:0.81-1;P=0.178;ICU length of stays group，OR:1.03;95%CI:0.96-1.11;P=0.544).Conclusion:anemia is common in the critically patients and results in a large number of RBCtransfusion.the number of RBC units transfused was not associated with the mortality.overall,a restrictive transfusion strategy is as effective as a liberal transfusion strategyin critically ill patients in ICU.