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

Background/objectives: Pediatric patients with sepsis are frequently subjected to red blood cell (RBC) transfusions but yet its association with mortality is still controversial.

Methods: 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.

Results: 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.

Conclusions: 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.