Lower versus higher hemoglobin threshold for transfusion in septic shock
Lars B Holst, Nicolai Haase, Jørn Wetterslev, Jan Wernerman, Anne B Guttormsen, Sari Karlsson, Pär I Johansson, Anders Aneman, Marianne L Vang, Robert Winding, Lars Nebrich, Helle L Nibro, Bodil S Rasmussen, Johnny R M Lauridsen, Jane S Nielsen, Anders Oldner, Ville Pettilä, Maria B Cronhjort, Lasse H Andersen, Ulf G Pedersen, Nanna Reiter, Jørgen Wiis, Jonathan O White, Lene Russell, Klaus J Thornberg, Peter B Hjortrup, Rasmus G Müller, Morten H Møller, Morten Steensen, Inga Tjäder, Kristina Kilsand, Suzanne Odeberg-Wernerman, Brit Sjøbø, Helle Bundgaard, Maria A Thyø, David Lodahl, Rikke Mærkedahl, Carsten Albeck, Dorte Illum, Mary Kruse, Per Winkel, Anders Perner, TRISS Trial Group, Scandinavian Critical Care Trials Group, Lars B Holst, Nicolai Haase, Jan Wernerman, Anne B Guttormsen, Sari Karlsson, Për I Johansson, Anders Åneman, Jørn Wetterslev, Anders Perner, Lars B Holst, Jørn Wetterslev, Anders Perner, Tim Walsh, Jacques Lacroix, Dean Fergusson, Daniel De Backer, Kathy Rowan, Jørgen H Petersen, L B Holst, A Perner, L H Andersen, U G Pedersen, N Reiter, J Wiis, J O White, L Russell, K J Thornberg, L Quist, M Ibsen, P B Hjortrup, R G Müller, M H Møller, M Steensen, C Claudius, M N Kjær, K R Uhre, V Christiansen, L H Nislev, F Sjøvall, I L Jarnvig, J Nielsen, H C Thorsen, P Bredahl, M Vang, H Bundgaard, M A Thyø, M Villumsen, J Wernerman, K Kilsand, I Tjäder, S O Wernerman, R Winding, D Lodahl, R Mærkedahl, N Dey, S Haubjerg, L Nebrich, C Albeck, A Christensen, H Nibro, D Keld, K Larsen, S E Dyrskog, D Illum, B Rasmussen, S N Granum, H H Bülow, J Elkjær, J R M Lauridsen, J S Nielsen, A B Guttormsen, B Sjøbø, A Oldner, O Friman, V Pettilä, L Pettilä, S Sutinen, M Cronhjort, B K Kristensen, P Kirkegaard, A Lindhardt, D G Strange, Elsebeth Haunstrup Krogh, Omar Rian, M Kruse, S Aagaard, M B Pawlowicz, J Madsen, L M Poulsen, P Berezowicz, M Chew, F Abdeen, W Müller, G Sternheden, S Holmstrøm, K Thormar, N Mtchedlishvili, K Strand, S Karlsson, S Varila, A Kukkurainen, A Bendtsen, M Reinikainen, S A Iversen, S Leivdal, P M Bådstøløkken, J Å Longva, R B Johansen, N Nielsen, J M Breider, Lars B Holst, Nicolai Haase, Jørn Wetterslev, Jan Wernerman, Anne B Guttormsen, Sari Karlsson, Pär I Johansson, Anders Aneman, Marianne L Vang, Robert Winding, Lars Nebrich, Helle L Nibro, Bodil S Rasmussen, Johnny R M Lauridsen, Jane S Nielsen, Anders Oldner, Ville Pettilä, Maria B Cronhjort, Lasse H Andersen, Ulf G Pedersen, Nanna Reiter, Jørgen Wiis, Jonathan O White, Lene Russell, Klaus J Thornberg, Peter B Hjortrup, Rasmus G Müller, Morten H Møller, Morten Steensen, Inga Tjäder, Kristina Kilsand, Suzanne Odeberg-Wernerman, Brit Sjøbø, Helle Bundgaard, Maria A Thyø, David Lodahl, Rikke Mærkedahl, Carsten Albeck, Dorte Illum, Mary Kruse, Per Winkel, Anders Perner, TRISS Trial Group, Scandinavian Critical Care Trials Group, Lars B Holst, Nicolai Haase, Jan Wernerman, Anne B Guttormsen, Sari Karlsson, Për I Johansson, Anders Åneman, Jørn Wetterslev, Anders Perner, Lars B Holst, Jørn Wetterslev, Anders Perner, Tim Walsh, Jacques Lacroix, Dean Fergusson, Daniel De Backer, Kathy Rowan, Jørgen H Petersen, L B Holst, A Perner, L H Andersen, U G Pedersen, N Reiter, J Wiis, J O White, L Russell, K J Thornberg, L Quist, M Ibsen, P B Hjortrup, R G Müller, M H Møller, M Steensen, C Claudius, M N Kjær, K R Uhre, V Christiansen, L H Nislev, F Sjøvall, I L Jarnvig, J Nielsen, H C Thorsen, P Bredahl, M Vang, H Bundgaard, M A Thyø, M Villumsen, J Wernerman, K Kilsand, I Tjäder, S O Wernerman, R Winding, D Lodahl, R Mærkedahl, N Dey, S Haubjerg, L Nebrich, C Albeck, A Christensen, H Nibro, D Keld, K Larsen, S E Dyrskog, D Illum, B Rasmussen, S N Granum, H H Bülow, J Elkjær, J R M Lauridsen, J S Nielsen, A B Guttormsen, B Sjøbø, A Oldner, O Friman, V Pettilä, L Pettilä, S Sutinen, M Cronhjort, B K Kristensen, P Kirkegaard, A Lindhardt, D G Strange, Elsebeth Haunstrup Krogh, Omar Rian, M Kruse, S Aagaard, M B Pawlowicz, J Madsen, L M Poulsen, P Berezowicz, M Chew, F Abdeen, W Müller, G Sternheden, S Holmstrøm, K Thormar, N Mtchedlishvili, K Strand, S Karlsson, S Varila, A Kukkurainen, A Bendtsen, M Reinikainen, S A Iversen, S Leivdal, P M Bådstøløkken, J Å Longva, R B Johansen, N Nielsen, J M Breider
Abstract
Background: Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established.
Methods: In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay. The primary outcome measure was death by 90 days after randomization.
Results: We analyzed data from 998 of 1005 patients (99.3%) who underwent randomization. The two intervention groups had similar baseline characteristics. In the ICU, the lower-threshold group received a median of 1 unit of blood (interquartile range, 0 to 3) and the higher-threshold group received a median of 4 units (interquartile range, 2 to 7). At 90 days after randomization, 216 of 502 patients (43.0%) assigned to the lower-threshold group, as compared with 223 of 496 (45.0%) assigned to the higher-threshold group, had died (relative risk, 0.94; 95% confidence interval, 0.78 to 1.09; P=0.44). The results were similar in analyses adjusted for risk factors at baseline and in analyses of the per-protocol populations. The numbers of patients who had ischemic events, who had severe adverse reactions, and who required life support were similar in the two intervention groups.
Conclusions: Among patients with septic shock, mortality at 90 days and rates of ischemic events and use of life support were similar among those assigned to blood transfusion at a higher hemoglobin threshold and those assigned to blood transfusion at a lower threshold; the latter group received fewer transfusions. (Funded by the Danish Strategic Research Council and others; TRISS ClinicalTrials.gov number, NCT01485315.).
Source: PubMed