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Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies

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Abstract
Background: Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies. Methods: We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010-2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation. Results: Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1-3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03-2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05-2.57], p = 0.03) analysis. Conclusions: RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death.
Keywords
Hematological malignancy, Severe sepsis, Septic shock, Anemia, Red blood cell transfusion, CRITICALLY-ILL PATIENTS, GOAL-DIRECTED RESUSCITATION, INTENSIVE-CARE-UNIT, SEVERE SEPSIS, HEMOGLOBIN THRESHOLD, CANCER-PATIENTS, SHOCK, TRIAL, MORTALITY, SURVIVAL

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MLA
Mirouse, Adrien, Matthieu Resche-Rigon, Virginie Lemiale, et al. “Red Blood Cell Transfusion in the Resuscitation of Septic Patients with Hematological Malignancies.” ANNALS OF INTENSIVE CARE 7 (2017): n. pag. Print.
APA
Mirouse, A., Resche-Rigon, M., Lemiale, V., Mokart, D., Kouatchet, A., Mayaux, J., Vincent, F., et al. (2017). Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies. ANNALS OF INTENSIVE CARE, 7.
Chicago author-date
Mirouse, Adrien, Matthieu Resche-Rigon, Virginie Lemiale, Djamel Mokart, Achille Kouatchet, Julien Mayaux, François Vincent, et al. 2017. “Red Blood Cell Transfusion in the Resuscitation of Septic Patients with Hematological Malignancies.” Annals of Intensive Care 7.
Chicago author-date (all authors)
Mirouse, Adrien, Matthieu Resche-Rigon, Virginie Lemiale, Djamel Mokart, Achille Kouatchet, Julien Mayaux, François Vincent, Martine Nyunga, Fabrice Bruneel, Antoine Rabbat, Christine Lebert, Pierre Perez, Anne Renault, Anne-Pascale Meert, Dominique Benoit, Rebecca Hamidfar, Mercé Jourdain, Michaël Darmon, Elie Azoulay, and Frédéric Pène. 2017. “Red Blood Cell Transfusion in the Resuscitation of Septic Patients with Hematological Malignancies.” Annals of Intensive Care 7.
Vancouver
1.
Mirouse A, Resche-Rigon M, Lemiale V, Mokart D, Kouatchet A, Mayaux J, et al. Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies. ANNALS OF INTENSIVE CARE. 2017;7.
IEEE
[1]
A. Mirouse et al., “Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies,” ANNALS OF INTENSIVE CARE, vol. 7, 2017.
@article{8551889,
  abstract     = {Background: Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies. 
Methods: We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010-2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation. 
Results: Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1-3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03-2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05-2.57], p = 0.03) analysis. 
Conclusions: RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death.},
  articleno    = {62},
  author       = {Mirouse, Adrien and Resche-Rigon, Matthieu and Lemiale, Virginie and Mokart, Djamel and Kouatchet, Achille and Mayaux, Julien and Vincent, François and Nyunga, Martine and Bruneel, Fabrice and Rabbat, Antoine and Lebert, Christine and Perez, Pierre and Renault, Anne and Meert, Anne-Pascale and Benoit, Dominique and Hamidfar, Rebecca and Jourdain, Mercé and Darmon, Michaël and Azoulay, Elie and Pène, Frédéric},
  issn         = {2110-5820},
  journal      = {ANNALS OF INTENSIVE CARE},
  keywords     = {Hematological malignancy,Severe sepsis,Septic shock,Anemia,Red blood cell transfusion,CRITICALLY-ILL PATIENTS,GOAL-DIRECTED RESUSCITATION,INTENSIVE-CARE-UNIT,SEVERE SEPSIS,HEMOGLOBIN THRESHOLD,CANCER-PATIENTS,SHOCK,TRIAL,MORTALITY,SURVIVAL},
  language     = {eng},
  pages        = {10},
  title        = {Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies},
  url          = {http://dx.doi.org/10.1186/s13613-017-0292-3},
  volume       = {7},
  year         = {2017},
}

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