DOES TRANSFUSION PRACTICE AFFECT MORTALITY IN CRITICALLY ILL PATIENTS

In 4,470 critically ill patients, we examined the impact of transfusio n practice on mortality rates. As compared with survivors, patients wh o died in intensive care units (ICU) had lower hemoglobin values (95 /- 26 versus 104 +/- 23 g/L, p < 0.0001) and were transfused red cells more frequently (42.6% versus 28.0%, p < 0.0001). In patients with ca rdiac disease, there was a trend toward an increased mortality when he moglobin values were < 95 g/L (55% versus 42%, p = 0.09) as compared w ith anemic patients with other diagnoses. Patients with anemia, a high APACHE II score (> 20), and a cardiac diagnosis had a significantly l ower mortality rate when given 1 to 3 or 4 to 6 units of allogeneic re d cells (55% [no transfusions] versus 35% [1 to 3 units] or 32% [4 to 6 units], respectively, p = 0.01). Adjusted odds ratio (OR) predicting survival were 0.61 (95% CI; 0.37 to 1.00, p = 0.026) after 1 to 3 uni ts and 0.49 (95% CI; 0.23 to 1.03, p = 0.03) after 4 to 6 units compar ed with nontransfused anemic patients. In the subgroup with cardiac di sease, increasing hemoglobin values in anemic patients was associated with improved survival (OR = 0.80 for each 10 g/L increase, p = 0.012) , We conclude that anemia increases the risk of death in critically il l patients with cardiac disease. Blood transfusions appear to decrease this risk.