Red blood cell transfusion during septic shock in the ICU

Background: Transfusion of red blood cells (RBCs) remains controversial in patients with septic shock, but current practice is unknown. Our aim was to evaluate RBC transfusion practice in septic shock in the intensive care unit (ICU), and patient characteristics and outcome associated with RBC transfusion.

Methods: Prospective cohort study of all adult patients with septic shock (n = 164) in six general ICUs during a 3-month period. Characteristics, other treatments, monitoring and outcome were compared in RBC-transfused and -non-transfused patients.

Results: Ninety-nine patients (95% confidence interval 87-111) received a median 900 ml (interquartile range 490-1405) of RBC during septic shock in ICU. Among transfused patients, there were more females [49/99 (49%) vs. 22/65 (34%), P = 0.048] and surgical patients [39/99 (39%) vs. 14/65 (22%), P = 0.02] than among patients not transfused. Also, admission simplified acute physiology score II was higher and minimal haemoglobin levels (days 1-3) were lower in transfused patients compared with those not transfused. In contrast, age, markers of shock and severity organ failure assessment score on day 1 and 90-day mortality did not differ between RBC-transfused and -non-transfused patients.

Conclusions: Most patients with septic shock received RBCs during shock, and these patients had higher disease severity and lower haemoglobin levels than those not transfused. In spite of this, mortality did not differ between groups neither in the unadjusted or adjusted analyses. However, neither the design nor the sample size allows us to make inferences about treatment effects, which underlines the need for large randomised, clinical trials on transfusion in septic shock.