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Vincent JL, Baron J, Reinhart K, et al. Anemia and Blood Transfusion in Critically Ill Patients. JAMA. 2002;288(12):1499–1507. doi:10.1001/jama.288.12.1499
Author Affiliations: Department of Intensive Care, Erasme University Hospital, Brussels, Belgium (Drs Vincent and Peres-Bota); Department of Anesthesiology, Hôpital Broussais, Paris, France (Dr Baron); Department of Anesthesiology, Klinikum FSU Jena, Jena, Germany (Drs Reinhart and Meier-Hellmann); Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano, Milan, Italy (Dr Gattinoni); Medical Intensive Care Unit, VU ziekenhuis, Amsterdam, the Netherlands (Dr Thijs); Department of Intensive Care, University College London Hospitals, London, England (Dr Webb); Department of Anesthesiology and Intensive Care, Onze Lieve Vrouwziekenhuis, Aalst, Belgium (Dr Nollet).
Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA.
Context Anemia is a common problem in critically ill patients admitted to intensive
care units (ICUs), but the consequences of anemia on morbidity and mortality
in the critically ill is poorly defined.
Objectives To prospectively define the incidence of anemia and use of red blood
cell (RBC) transfusions in critically ill patients and to explore the potential
benefits and risks associated with transfusion in the ICU.
Design Prospective observational study conducted November 1999, with 2 components:
a blood sampling study and an anemia and blood transfusion study.
Setting and Patients The blood sampling study included 1136 patients from 145 western European
ICUs, and the anemia and blood transfusion study included 3534 patients from
146 western European ICUs. Patients were followed up for 28 days or until
hospital discharge, interinstitutional transfer, or death.
Main Outcome Measures Frequency of blood drawing and associated volume of blood drawn, collected
over a 24-hour period; hemoglobin levels, transfusion rate, organ dysfunction
(assessed using the Sequential Organ Failure Assessment score), and mortality,
collected throughout a 2-week period.
Results The mean (SD) volume per blood draw was 10.3 (6.6) mL, with an average
total volume of 41.1 (39.7) mL during the 24-hour period. There was a positive
correlation between organ dysfunction and the number of blood draws (r = 0.34; P<.001) and total
volume drawn (r = 0.28; P<.001).
The mean hemoglobin concentration at ICU admission was 11.3 (2.3) g/dL, with
29% (963/3295) having a concentration of less than 10 g/dL. The transfusion
rate during the ICU period was 37.0% (1307/3534). Older patients and those
with a longer ICU length of stay were more commonly transfused. Both ICU and
overall mortality rates were significantly higher in patients who had vs had
not received a transfusion (ICU rates: 18.5% vs 10.1%, respectively; χ2 = 50.1; P<.001; overall rates: 29.0% vs
14.9%, respectively; χ2 = 88.1; P<.001).
For similar degrees of organ dysfunction, patients who had a transfusion had
a higher mortality rate. For matched patients in the propensity analysis,
the 28-day mortality was 22.7% among patients with transfusions and 17.1%
among those without (P = .02); the Kaplan-Meier log-rank
test confirmed this difference.
Conclusions This multicenter observational study reveals the common occurrence of
anemia and the large use of blood transfusion in critically ill patients.
Additionally, this epidemiologic study provides evidence of an association
between transfusions and diminished organ function as well as between transfusions
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