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RBC Transfusion Practices in Critically Ill Patients With Sepsis.

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Title: RBC Transfusion Practices in Critically Ill Patients With Sepsis.
Authors: Song MJ; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea., Seo WI; Office of Hospital Information, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea., Jang Y; Office of Hospital Information, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea., Park S; Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea., Ko R; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Suh GY; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea., Oh DK; Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Lee SY; Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Park MH; Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Lim CM; Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Jung SY; Office of Hospital Information, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea., Lim SY; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Corporate Authors: Korean Sepsis Alliance (KSA) Investigators
Source: Critical care medicine [Crit Care Med] 2025 Dec 01; Vol. 53 (12), pp. e2596-e2606. Date of Electronic Publication: 2025 Oct 15.
Publication Type: Journal Article; Observational Study; Multicenter Study
Language: English
Journal Info: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE
Imprint Name(s): Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: New York, Kolen.
MeSH Terms: Sepsis*/therapy , Sepsis*/mortality , Erythrocyte Transfusion*/statistics & numerical data , Erythrocyte Transfusion*/methods , Erythrocyte Transfusion*/mortality , Critical Illness*/therapy , Critical Illness*/mortality, Humans ; Male ; Female ; Aged ; Prospective Studies ; Middle Aged ; Intensive Care Units/statistics & numerical data ; Republic of Korea/epidemiology ; Hemoglobins/analysis ; Aged, 80 and over ; Propensity Score ; Simplified Acute Physiology Score
Abstract: Objective: To assess real-world RBC transfusion practices during early resuscitation in sepsis and evaluate their association with 60-day mortality.
Design: Secondary analysis of a prospective, multicenter observational cohort (the Korean Sepsis Alliance cohort) from September 2019 to December 2022.
Setting: Thirteen ICUs across South Korea.
Patients: Adults (19 yr old or older) admitted to the ICU with sepsis were categorized into transfused and non-transfused groups based on whether they received RBC transfusions during ICU days 1-3.
Interventions: None.
Measurements and Main Results: Among 2613 patients (mean age 71.9 ± 13.3 yr old), 45.3% received RBC transfusions during the early resuscitation phase. The mean lowest hemoglobin level on the day of transfusion was 8.8 ± 1.7 g/dL. RBC transfusion was associated with clinical factors beyond hemoglobin levels, including higher Simplified Acute Physiology Score 3 and Sepsis-Induced Coagulopathy scores, septic shock, surgical source control, elevated lactate and bilirubin levels, low platelet counts, the use of two or more vasopressors, and continuous renal replacement therapy. In the propensity score-matched cohort, there was no overall difference in 60-day mortality between groups. However, a significant qualitative interaction was observed when stratifying by an ICU day 1 hemoglobin threshold of 10 g/dL ( p for interaction = 0.0124). RBC transfusion was linked to higher mortality at hemoglobin greater than or equal to 10 g/dL, but showed a trend toward decreased mortality below this threshold.
Conclusions: RBC transfusions are common in critically ill patients with sepsis, highlighting a gap between clinical practice and guideline recommendations. Although not associated with overall mortality, a qualitative interaction was observed at a hemoglobin threshold of 10 g/dL. Transfusion decisions may be guided by physiologic markers up to 9-10 g/dL, but should be avoided when hemoglobin levels exceed 10 g/dL due to the potential for harm.
(Copyright © 2025 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
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Contributed Indexing: Investigator: J Heo, Kangwon National University Hospital.; JM Lee, Korea University Anam Hospital.; KC Kim, Daegu Catholic University Hospital.; YJ Lee, Seoul National University Bundang Hospital.; Y Chang, Inje University Sanggye Paik Hospital.; K Jeon, Samsung Medical Center.; SM Lee, Seoul National University Hospital.; SK Hong, Asan Medical Center.; WH Cho, Pusan National University Yangsan Hospital.; SH Kwak, Chonnam National University Hospital.; HB Lee, Jeonbuk National University Hospital.; JJ Ahn, Ulsan University Hospital.; GM Seong, Jeju National University Hospital.; SI Lee, Chungnam National University Hospital.; TS Park, Hanyang University Guri Hospital.; SH Lee, Severance Hospital.; EY Choi, Yeungnam University Medical Center.; JY Moon, Chungnam National University Sejong Hospital.; HK Kang, Inje University Ilsan Paik Hospital.
Keywords: critically ill; mortality; red blood cell; sepsis; transfusion
Substance Nomenclature: 0 (Hemoglobins)
Entry Date(s): Date Created: 20251015 Date Completed: 20251204 Latest Revision: 20251204
Update Code: 20251204
DOI: 10.1097/CCM.0000000000006892
PMID: 41090988
Database: MEDLINE
Description
Abstract:Objective: To assess real-world RBC transfusion practices during early resuscitation in sepsis and evaluate their association with 60-day mortality.<br />Design: Secondary analysis of a prospective, multicenter observational cohort (the Korean Sepsis Alliance cohort) from September 2019 to December 2022.<br />Setting: Thirteen ICUs across South Korea.<br />Patients: Adults (19 yr old or older) admitted to the ICU with sepsis were categorized into transfused and non-transfused groups based on whether they received RBC transfusions during ICU days 1-3.<br />Interventions: None.<br />Measurements and Main Results: Among 2613 patients (mean age 71.9 ± 13.3 yr old), 45.3% received RBC transfusions during the early resuscitation phase. The mean lowest hemoglobin level on the day of transfusion was 8.8 ± 1.7 g/dL. RBC transfusion was associated with clinical factors beyond hemoglobin levels, including higher Simplified Acute Physiology Score 3 and Sepsis-Induced Coagulopathy scores, septic shock, surgical source control, elevated lactate and bilirubin levels, low platelet counts, the use of two or more vasopressors, and continuous renal replacement therapy. In the propensity score-matched cohort, there was no overall difference in 60-day mortality between groups. However, a significant qualitative interaction was observed when stratifying by an ICU day 1 hemoglobin threshold of 10 g/dL ( p for interaction = 0.0124). RBC transfusion was linked to higher mortality at hemoglobin greater than or equal to 10 g/dL, but showed a trend toward decreased mortality below this threshold.<br />Conclusions: RBC transfusions are common in critically ill patients with sepsis, highlighting a gap between clinical practice and guideline recommendations. Although not associated with overall mortality, a qualitative interaction was observed at a hemoglobin threshold of 10 g/dL. Transfusion decisions may be guided by physiologic markers up to 9-10 g/dL, but should be avoided when hemoglobin levels exceed 10 g/dL due to the potential for harm.<br /> (Copyright © 2025 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
ISSN:1530-0293
DOI:10.1097/CCM.0000000000006892