The association of red blood cell transfusion with mortality in pediatric patients with sepsis, severe sepsis, and septic shock: A single-center retrospective cohort study
•Lower hemoglobin, increased CRP, and lower platelets count are related to the RBC transfusion in pediatrics with sepsis.•RBC transfusions are associated with increased ICU length of stay in pediatrics with sepsis.•RBC transfusions are not associated with 28-day mortality and mechanical ventilation...
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Published in | Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine Vol. 32; no. 1; pp. 62 - 68 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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France
Elsevier Masson SAS
01.02.2025
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ISSN | 1246-7820 1953-8022 1953-8022 |
DOI | 10.1016/j.tracli.2024.12.002 |
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Abstract | •Lower hemoglobin, increased CRP, and lower platelets count are related to the RBC transfusion in pediatrics with sepsis.•RBC transfusions are associated with increased ICU length of stay in pediatrics with sepsis.•RBC transfusions are not associated with 28-day mortality and mechanical ventilation rate in pediatrics with sepsis.•Younger age, use of mechanical ventilation, and more severe disease are associated with increased mortality in pediatrics with sepsis.
Pediatric patients with sepsis are frequently subjected to red blood cell (RBC) transfusions but yet its association with mortality is still controversial.
We consecutively selected 125 patients with sepsis, severe sepsis, and septic shock admitted to intensive care unit (ICU) in our center from January 2022 to January 2023, and finally 100 patients were included in this retrospective cohort study. The patients were divided into two groups: group I who received RBC transfusion and group II who did not receive RBC transfusion. Logistic regression analysis was used to determine the demographic and clinical factors related to receiving RBC transfusion. The association of RBC transfusion with mortality was determined by the Cox regression model, and the mechanical ventilation rate and length of stay by the logistic regression model.
Among the 100 patients, 67 and 33 cases belonged to the RBC-transfused and not-transfused groups, respectively. Lower hemoglobin level (OR = 0.918, 95%CI: 0.881–0.957, p < 0.001), increased c-reactive protein level (OR = 1.022, 95%CI: 1.002–1.043, p = 0.034), and lower platelets count (OR = 0.994, 95%CI: 0.988–0.999, p = 0.023) were associated with RBC transfusions. While the associations of RBC transfusion with mortality and mechanical ventilation were not shown to be statistically significant (HR = 3.926, 95%CI: 0.952–16.186, p = 0.058 and OR = 2.588, 95%CI: 0.832–8.046, p = 0.1), RBC transfusion might be associated with increased ICU length of stay (OR = 16.477, 95%CI: 3.86–70.342, p < 0.001). In the overall survival analysis, younger age (HR = 0.093, 95%CI: 0.027–0.320, p < 0.001), the use of mechanical ventilation (HR = 8.893, 95%CI: 1.483–53.336, p = 0.017), and more severe disease (severe sepsis vs. sepsis, HR = 24.531, 95%CI: 1.923–321.914, p = 0.014; septic shock vs. sepsis, HR = 32.187, 95%CI: 2.977–347.949, p = 0.004) were related to increased mortality.
RBC transfusions are significantly associated with increased ICU length of stay and not associated with 28-day mortality and mechanical ventilation rate. Other factors affecting mortality in pediatric patients with sepsis, severe sepsis, and septic shock are younger age, use of mechanical ventilation, and more severe disease. |
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AbstractList | Pediatric patients with sepsis are frequently subjected to red blood cell (RBC) transfusions but yet its association with mortality is still controversial.
We consecutively selected 125 patients with sepsis, severe sepsis, and septic shock admitted to intensive care unit (ICU) in our center from January 2022 to January 2023, and finally 100 patients were included in this retrospective cohort study. The patients were divided into two groups: group I who received RBC transfusion and group II who did not receive RBC transfusion. Logistic regression analysis was used to determine the demographic and clinical factors related to receiving RBC transfusion. The association of RBC transfusion with mortality was determined by the Cox regression model, and the mechanical ventilation rate and length of stay by the logistic regression model.
Among the 100 patients, 67 and 33 cases belonged to the RBC-transfused and not-transfused groups, respectively. Lower hemoglobin level (OR = 0.918, 95%CI: 0.881-0.957, p < 0.001), increased c-reactive protein level (OR = 1.022, 95%CI: 1.002-1.043, p = 0.034), and lower platelets count (OR = 0.994, 95%CI: 0.988-0.999, p = 0.023) were associated with RBC transfusions. While the associations of RBC transfusion with mortality and mechanical ventilation were not shown to be statistically significant (HR = 3.926, 95%CI: 0.952-16.186, p = 0.058 and OR = 2.588, 95%CI: 0.832-8.046, p = 0.1), RBC transfusion might be associated with increased ICU length of stay (OR = 16.477, 95%CI: 3.86-70.342, p < 0.001). In the overall survival analysis, younger age (HR = 0.093, 95%CI: 0.027-0.320, p < 0.001), the use of mechanical ventilation (HR = 8.893, 95%CI: 1.483-53.336, p = 0.017), and more severe disease (severe sepsis vs. sepsis, HR = 24.531, 95%CI: 1.923-321.914, p = 0.014; septic shock vs. sepsis, HR = 32.187, 95%CI: 2.977-347.949, p = 0.004) were related to increased mortality.
RBC transfusions are significantly associated with increased ICU length of stay and not associated with 28-day mortality and mechanical ventilation rate. Other factors affecting mortality in pediatric patients with sepsis, severe sepsis, and septic shock are younger age, use of mechanical ventilation, and more severe disease. •Lower hemoglobin, increased CRP, and lower platelets count are related to the RBC transfusion in pediatrics with sepsis.•RBC transfusions are associated with increased ICU length of stay in pediatrics with sepsis.•RBC transfusions are not associated with 28-day mortality and mechanical ventilation rate in pediatrics with sepsis.•Younger age, use of mechanical ventilation, and more severe disease are associated with increased mortality in pediatrics with sepsis. Pediatric patients with sepsis are frequently subjected to red blood cell (RBC) transfusions but yet its association with mortality is still controversial. We consecutively selected 125 patients with sepsis, severe sepsis, and septic shock admitted to intensive care unit (ICU) in our center from January 2022 to January 2023, and finally 100 patients were included in this retrospective cohort study. The patients were divided into two groups: group I who received RBC transfusion and group II who did not receive RBC transfusion. Logistic regression analysis was used to determine the demographic and clinical factors related to receiving RBC transfusion. The association of RBC transfusion with mortality was determined by the Cox regression model, and the mechanical ventilation rate and length of stay by the logistic regression model. Among the 100 patients, 67 and 33 cases belonged to the RBC-transfused and not-transfused groups, respectively. Lower hemoglobin level (OR = 0.918, 95%CI: 0.881–0.957, p < 0.001), increased c-reactive protein level (OR = 1.022, 95%CI: 1.002–1.043, p = 0.034), and lower platelets count (OR = 0.994, 95%CI: 0.988–0.999, p = 0.023) were associated with RBC transfusions. While the associations of RBC transfusion with mortality and mechanical ventilation were not shown to be statistically significant (HR = 3.926, 95%CI: 0.952–16.186, p = 0.058 and OR = 2.588, 95%CI: 0.832–8.046, p = 0.1), RBC transfusion might be associated with increased ICU length of stay (OR = 16.477, 95%CI: 3.86–70.342, p < 0.001). In the overall survival analysis, younger age (HR = 0.093, 95%CI: 0.027–0.320, p < 0.001), the use of mechanical ventilation (HR = 8.893, 95%CI: 1.483–53.336, p = 0.017), and more severe disease (severe sepsis vs. sepsis, HR = 24.531, 95%CI: 1.923–321.914, p = 0.014; septic shock vs. sepsis, HR = 32.187, 95%CI: 2.977–347.949, p = 0.004) were related to increased mortality. RBC transfusions are significantly associated with increased ICU length of stay and not associated with 28-day mortality and mechanical ventilation rate. Other factors affecting mortality in pediatric patients with sepsis, severe sepsis, and septic shock are younger age, use of mechanical ventilation, and more severe disease. |
Author | Jin, Xiaobo Wang, Ting Chen, Xuejun Qu, Xinli Ma, Jihua Xu, Jun Yin, Mingwei Jiang, Qian |
Author_xml | – sequence: 1 givenname: Mingwei surname: Yin fullname: Yin, Mingwei organization: Department of Blood Transfusion, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, PR China – sequence: 2 givenname: Ting surname: Wang fullname: Wang, Ting organization: Department of Blood Transfusion, Tai’an Traditional Chinese Medicine Hospital, Tai’an, Shandong Province, PR China – sequence: 3 givenname: Qian surname: Jiang fullname: Jiang, Qian organization: Department of Blood Transfusion, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, PR China – sequence: 4 givenname: Xinli surname: Qu fullname: Qu, Xinli organization: School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, PR China – sequence: 5 givenname: Jihua surname: Ma fullname: Ma, Jihua organization: Department of Blood Transfusion, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, PR China – sequence: 6 givenname: Jun surname: Xu fullname: Xu, Jun organization: Department of Blood Transfusion, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, PR China – sequence: 7 givenname: Xiaobo surname: Jin fullname: Jin, Xiaobo organization: Department of Blood Transfusion, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, PR China – sequence: 8 givenname: Xuejun surname: Chen fullname: Chen, Xuejun email: chxjs@zju.edu.cn organization: Department of Blood Transfusion, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, PR China |
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Keywords | Pediatrics Sepsis RBC transfusion Mortality |
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campaign: international guidelines for management of severe sepsis and septic shock: 2012 publication-title: Crit Care Med doi: 10.1097/CCM.0b013e31827e83af |
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Snippet | •Lower hemoglobin, increased CRP, and lower platelets count are related to the RBC transfusion in pediatrics with sepsis.•RBC transfusions are associated with... Pediatric patients with sepsis are frequently subjected to red blood cell (RBC) transfusions but yet its association with mortality is still controversial. We... |
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SubjectTerms | Adolescent Child Child, Preschool Cohort Studies Erythrocyte Transfusion - adverse effects Erythrocyte Transfusion - mortality Female Hospital Mortality Humans Infant Intensive Care Units Length of Stay - statistics & numerical data Male Mortality Pediatrics RBC transfusion Respiration, Artificial - statistics & numerical data Retrospective Studies Sepsis Sepsis - blood Sepsis - mortality Sepsis - therapy Shock, Septic - blood Shock, Septic - mortality Shock, Septic - therapy |
Title | The association of red blood cell transfusion with mortality in pediatric patients with sepsis, severe sepsis, and septic shock: A single-center retrospective cohort study |
URI | https://dx.doi.org/10.1016/j.tracli.2024.12.002 https://www.ncbi.nlm.nih.gov/pubmed/39710203 https://doi.org/10.1016/j.tracli.2024.12.002 |
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