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March 12, 2003

Blood Transfusions and Mortality Among Critically Ill PatientsBlood Transfusions and Mortality Among Critically Ill Patients

JAMA. 2003;289(10):1242-1243. doi:10.1001/jama.289.10.1242-a

To the Editor: Dr Vincent and colleagues1 reported an association between transfusions and mortality in critically ill patients. Although the patients who received transfusions were sicker with higher organ dysfunction scores, and were more likely to be in shock, the authors attempted to match patients based on similar propensity scores. However, some of the variables used in their model, including the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and presence of shock on admission predict mortality among critically ill patients more accurately than other variables in their model. We therefore wonder how the authors weighted the individual variables in their propensity score model. Of the 1307 patients who received transfusions, the authors were able to match only 516. We question how representative these 516 were of the total number of patients who received transfusions. This is especially important since the authors state that mortality rates between transfused and nontransfused critically ill patients were similar in the "sickest" patients.