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 inTransfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine Vol. 32; no. 1; pp. 62 - 68
Main Authors Yin, Mingwei, Wang, Ting, Jiang, Qian, Qu, Xinli, Ma, Jihua, Xu, Jun, Jin, Xiaobo, Chen, Xuejun
Format Journal Article
LanguageEnglish
Published France Elsevier Masson SAS 01.02.2025
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ISSN1246-7820
1953-8022
1953-8022
DOI10.1016/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.
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
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Issue 1
Keywords Pediatrics
Sepsis
RBC transfusion
Mortality
Language English
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Copyright © 2024 Society francophone de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.
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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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pubmed
crossref
elsevier
SourceType Open Access Repository
Index Database
Publisher
StartPage 62
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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