The Association between Red Blood Cell Transfusion and Hospital Mortality in Critically Ill Surgical Patients: The Multi-center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study)
Annop Piriyapatsom MD*1, Chawika Pisitsak MD*2, Kaweesak Chittawatanarat MD, PhD*3, Onuma Chaiwat MD*1, Suneerat Kongsayreepong MD*1, the THAI-SICU study group
Affiliation : *1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *2 Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *3 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Objective : Red blood cell transfusion (RBCT) is commonly prescribed to critically ill patients with anemia. Nevertheless, the
benefits of RBCT in these patients, particularly critically ill surgical patients, are still controversial. The aim of this study is to
explore the association between RBCT and hospital mortality in Thai critically ill surgical patients.
Material and Method: This study was a part of the multi-center, prospective, observational study, which included adult
patients admitted to the SICUs after surgery. Patients were categorized into transfusion and no transfusion groups according
to whether they received RBCT during SICU stay or not. The multiple logistic regression analysis was performed to determine
whether RBCT was an independent risk factor for hospital mortality. The patients were also matched between two groups
based on the propensity score for RBCT requirement and were then compared.
Results : There were 2,531 patients included in this study. The incidence of RBCT in SICU was 40.3%. Overall, there was no
association between RBCT in SICU and hospital mortality (adjusted OR 1.33, 95% CI 0.83-2.11) except in the subgroup of
patients with age of <65 years old (adjusted OR 1.99, 95% CI 1.03-3.84). However, when the amount of RBCT was more
than 1,200 mL, it was independently associated with increased hospital mortality (adjusted OR 2.55, 95% CI 1.35-4.81). In
the propensity-score matching cohort, there was no association between RBCT in SICU and hospital mortality (adjusted
OR 1.56, 95% CI 0.88-2.77) except when the amount of RBCT was more than 600 mL (601-1,200 mL, adjusted OR 3.14,
95% CI 1.47-6.72 and >1,200 mL, adjusted OR 3.58, 95% CI 1.36-9.48).
Conclusion : RBCT should be considered as a life-saving intervention but with potential risks of adverse events. Identifying
patients who will likely gain benefit from RBCT and implementing the restrictive transfusion strategy may be the keys to
improve outcomes.
Keywords : Blood transfusion, Critical care, Mortality, Outcomes, Surgical patients
