Transfusional profile in different types of intensive care units

Paula, Ilusca Cardoso de; Azevedo, Luciano Cesar Pontes; Falcão, Luiz Fernando dos Reis; Mazza, Bruno Franco; Barros, Melca Maria Oliveira; Freitas, Flavio Geraldo Rezende; Machado, Flávia Ribeiro

doi:10.1016/j.bjane.2013.07.012

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Scientific Articles • Rev. Bras. Anestesiol. 64 (03) • May-Jun 2014 • https://doi.org/10.1016/j.bjane.2013.07.012 copy

Transfusional profile in different types of intensive care units^☆ ☆ Study conducted at Hospital Sao Paulo, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background and objectives:

anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units.

Methods:

prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05.

Results:

408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49%) and active bleeding (32%). The median number of units transfused per episode was 2 (1-2) and the median storage time was 14 (7-21) days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics.

Conclusions:

the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

Transfusion; Hemoglobin; Intensive therapy unit; Blood components

Variable	Global	UTI general	UTI supplementary health	UTI internal medicine	UTI pneumology	UTI cardiology	p value
Patients (n)	71	28	12	13	12	6	–
Age (years)	63 (43–73)	52 (36–72)	62 (47–70)	54 (38–74)	68 (42–73)	70 (63–77)	0.45
Male gender	33 (46)	15 (52)	6 (50)	5 (39)	4 (33)	3 (50)	0.76

Admission type							0.001
Clinical	35 (49)	6 (21)	4 (33)	11 (85)	9 (75)	5 (83)
Surgical, elective	21 (27)	10 (36)	5 (41)	2 (15)	3 (25)	1 (17)
Surgical, urgency	15 (21)	12 (43)	3 (25)	0 (0)	0 (0)	0 (0)

Syndromic diagnoses							0.20
Sepsis	10 (14)	5 (18)	0 (0)	4 (31)	0 (0)	1 (17)
Severe sepsis	16 (22)	7 (25)	1 (8)	4 (31)	4 (33)	0 (0)
Septic shock	15 (21)	5 (18)	2 (17)	2 (15)	3 (25)	3 (50)
ARDS	9 (12)	1 (4)	0 (0)	0 (0)	1 (8)	1 (17)
Acute COI	3 (4)	5 (18)	2 (17)	1 (8)	1 (8)	0 (0)
Other diagnoses	18 (25)	5 (18)	7 (58)	2 (15)	3 (25)	1 (17)
Chronic COI	10 (14)	5 (18)	1 (8)	1 (8)	0 (0)	3 (50)	0.05
APACHE II	17.7 ± 5.3	17.3 ± 5.1	14.5 ± 5.5	17.6 ± 3.7	20.2 ± 7.1	20.5 ± 3.2	0.10
SOFA of day initial transfusion	5 (4.7)	6 (4.7)	5 (3.10)	4 (3.7)	4 (2.6)	5 (3.7)	0.66
Hb at ICU admission (g/dL)	9.7 ± 2.3	9.9 ± 2.4	10.2 ± 2.6	8.8 ± 2.2	9.6 ± 2.1	9.6 ± 1.1	0.58
Vasoprssors	47 (66)	18 (64)	5 (41)	11 (85)	7 (58)	6 (100)	0.15
Inotropes	31 (43)	19 (68)	3 (25)	3 (23)	1 (8)	5 (83)	0.001
VM use	63 (89)	27 (96)	7 (58)	12 (92)	12 (100)	5 (83)	0.08
ICU hospitalization time (days)	23 (11–38)	27 (15–41)	12 (2–20)	16 (10–38)	34 (9–40)	28 (14–68)	0.06
Mortality at 28 days	33 (46)	10 (36)	6 (50)	7 (54)	5 (42)	5 (83)	0.26
Mortality at 60 days	38 (54)	12 (43)	7 (58)	9 (69)	7 (58)	5 (83)	0.35

Variable	Global	UTI general	UTI supplementary health	UTI internal medicine	UTI pneumology	UTI cardiology	p value
Transfusion episodes (n)	241	109	25	58	27	23	–
Hb at transfusion indication (g/dL)	6.8 (6.35–7.4)	6.7 (6.4–7.05)	7.2 (6.25–7.85)	6.4 (5.67–6.92)	7.4 (6.85–7.8)	7.5 (7.1–8.6)	<0.001
Transfusions with Hb > 7g/dL	96 (39.8)	31 (28.4)	14 (56.0)	14 (24.1)	19 (73.1)	18 (78.3)	<0.001

Indication of transfusion							<0.001
Low hemoglobin	116 (49.8)	60 (58.8)	6 (25.0)	30 (50.8)	10 (40.0)	10 (43.5)	–
Active bleeding	74 (31.8)	27 (26.5)	3 (12.5)	27 (45.8)	4 (16.0)	13 (56.5)	–
Acute COI	14 (6.0)	6 (5.9)	5 (20.8)	0 (0)	3 (12.0)	0 (0)	–
Heart failure	6 (2.6)	0 (0)	6 (25.0)	0 (0)	0 (0)	0 (0)	–
Surgical procedure	3 (1.3)	0 (0)	0 (0)	2 (3.4)	1 (4)	0 (0)	–
Other	20 (8.6)	9 (8.8)	4 (16.7)	0 (0)	7 (28.0)	0 (0)	–

Bags/transfusional episode (n)	2 (1.2)	1 (1.2)	2 (1.2)	2 (2.2)	2 (1.2)	2 (2.2)	<0.001
Storage time for bags (days) ^a	14 (7–21)	15 (10–23)	11 (6–19)	11 (6–20)	11 (6–19.5)	16 (14–21)	0.002

Complications	Total of transfunded bags (n)	p value	Storage time (days)	p value
Respiratory
Yes (n = 16)	5 (2–12.2)	0.48	15.3 (8.6–19.9)	0.38
No (n = 55)	4 (2–7)		11.6 (6.6–20.3)

Renal
Yes (n = 28)	4 (2–6.5)	0.57	15 (10.4–20.3)	0.30
No (n = 43)	4 (2–12)		115 (6–18.6)

Infectious
Yes (n = 62)	4 (2–8.5)	0.15	15 (7.3–26.5)	0.41
No (n = 9)	3 (1–4)		12.7 (7–18.6)

Progression of SOFA ?0 - ?7 ^a
Worsening/no change (n = 26)	5 (3–13.5)	0.35	15 (7.9–22.2)	0.36
Improvement (n = 21)	5 (2–8)		11.5 (7–16.1)

Variable	Total of transfunded bags			Mean time of storage
	<3 transfusions	=3 transfusions	p value	<14 days	>14 days	p value
ICU time (days)	12 (4.5–24.0)	28.5 (16.2–41.5)	0.002	23 (6.5–47.7)	27 (15.5–38.5)	0.38
MV time (days)	11 (2.5–16.0)	23 (7.2–35.7)	0.008	15 (3–35)	15 (7–30)	0.93
Vasopressor time (days)	1 (0–4.0)	3 (0.2–8.0)	0.09	3 (1–8.5)	3 (0–6)	0.30
Mortality 28 days	7 (33.3)	26 (53.1)	0.13	18 (50)	15 (44.1)	0.62
Mortality 60 days	8 (38.1)	30 (63.8)	0.05	21 (58.3)	17 (53.1)	0.66

Variable	Survivors (n = 30)	Not survivors (n = 38)	OR (IC 95%)	p value
Age (years)	62 (33.7–70)	66.5 (45.7–73.2)	1.015 (0.988–1.043)	0.27
Male	13 (43)	19 (50)	0.765 (0.292–2.002)	0.58
APACHE II	16.9 ± 5.1	18.5 ± 5.5	1.061 (0.963–1.169)	0.23
Admission SOFA (points)	5 (2.5–6.5)	6 (4–8.7).	1.228 (1.022–1.477)	0.02
Admission Hb (g/dl)	9.7 ± 2.0	9.7 ± 2.4	0.984 (0.790–1.225)	0.88
Pre-transfusion Hb (g/dl)	7.1 ± 1.1	6.9 ± 1.3	0.875 (0.594–1.228)	0.49
Storage time for bags (days)	14.2 (8.3–22.3)	11.2 (6.3–16.4)	0.949 (0.887–1.014)	0.12
Total transfused bags (n)	3 (2–5.2)	5 (3–9.2)	1.072 (0.964–1.193)	0.19
Presence of active bleeding	10 (30)	15 (40)	1.067 (0.326–3.945)	0.91
ICU time (days)	26 (12.5–40.2)	22 (10.2–37)	0.990 (0.973–1.008)	0.27
MV time (days)	15 (1.7–31)	16 (6.7–35)	0.997 (0.975–1.019)	0.78
Use of MV	25 (83)	37 (97)	7.400 (0.815–7.199)	0.04
Vasopressors	13 (43)	34 (90)	11.115 (3.144–39.299)	<0.001

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author.E-mail: fmachado.dcir@epm.br (F.R. Machado).

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Transfusional profile in different types of intensive care units☆ ☆ Study conducted at Hospital Sao Paulo, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.

Background and objectives:

Methods:

Results:

Conclusions:

Transfusional profile in different types of intensive care units^☆ ☆ Study conducted at Hospital Sao Paulo, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.