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

被引：12

作者：

Mirouse, Adrien ^{[1
,2
]}

Resche-Rigon, Matthieu ^{[3
,4
]}

Lemiale, Virginie ^{[5
,6
]}

Mokart, Djamel ^{[7
]}

Kouatchet, Achille ^{[8
]}

Mayaux, Julien ^{[9
,10
]}

Vincent, Francois ^{[11
]}

Nyunga, Martine ^{[12
]}

Bruneel, Fabrice ^{[13
]}

Rabbat, Antoine ^{[15
]}

Lebert, Christine ^{[14
,16
]}

Perez, Pierre ^{[17
]}

Renault, Anne ^{[18
]}

Meert, Anne-Pascale ^{[19
]}

Benoit, Dominique ^{[20
]}

Hamidfar, Rebecca ^{[21
]}

Jourdain, Merce ^{[22
,23
]}

Darmon, Michael ^{[24
]}

Azoulay, Elie ^{[5
,6
]}

Pene, Frederic ^{[1
,2
]}

机构：

[1] Hop Cochin, AP HP, Reanimat Med, 27 Rue Faubourg St Jacques, F-75014 Paris, France

[2] Univ Paris 05, 27 Rue Faubourg St Jacques, F-75014 Paris, France

[3] Hop St Louis, AP HP, Dept Biostat, Paris, France

[4] Univ Paris Diderot, Paris, France

[5] Hop St Louis, AP HP, Reanimat Med, Paris, France

[6] Univ Paris Diderot, Paris, France

[7] Inst Paoli Calmettes, Dept Anesthesie Reanimat, Marseille, France

[8] CHU Angers, Reanimat Med & Med Hyperbare, Angers, France

[9] Hop La Pitie Salpetriere, AP HP, Reanimat Med, Paris, France

[10] Univ Paris 06, Paris, France

[11] Ctr Hosp Intercommunal, Reanimat Polyvalente, Montfermeil, France

[12] Ctr Hosp Roubaix, Roubaix, France

[13] Hop Andre Mignot, Reanimat Polyvalente, Le Chesnay, France

[14] Hop Cochin, AP HP, Unite Soins Intensifs Resp, Paris, France

[15] Univ Paris 05, Paris, France

[16] Ctr Hosp Dept, Reanimat Polyvalente, Roche Sur Yon, France

[17] Hop Brabois, Reanimat Med, Nancy, France

[18] Ctr Hosp Brest, Reanimat Med, Brest, France

[19] Inst Jules Bordet, Serv Soins Intensifs & Urgences Oncolog, Brussels, Belgium

[20] Ghent Univ Hosp, Ghent, Belgium

[21] CHU Grenoble, Reanimat Med, Grenoble, France

[22] Univ Lille, Lille, France

[23] CHU Lille, Reanimat Polyvalente, Lille, France

[24] Ctr Hosp St Etienne, Reanimat Med, St Etienne, France

来源：

ANNALS OF INTENSIVE CARE | 2017年 / 7卷

关键词：

Hematological malignancy; Severe sepsis; Septic shock; Anemia; Red blood cell transfusion; GOAL-DIRECTED RESUSCITATION; CRITICALLY-ILL PATIENTS; SEVERE SEPSIS; HEMOGLOBIN THRESHOLD; CANCER-PATIENTS; SHOCK; MORTALITY; SURVIVAL; IMPACT; REQUIREMENTS;

D O I：

10.1186/s13613-017-0292-3

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Indications 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. Methods: We 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. Results: Among 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. Conclusions: RBC 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.

引用

页数：10

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