Efficacy of recombinant human erythropoietin in the critically ill patient: A randomized, double-blind, placebo-controlled trial

Objective: To determine whether the administration of recombinant human ery thropoietin (rHuEPO) to critically ill patients in the intensive care unit (ICU) would reduce the number of red blood cell (RBC) transfusions required . Design: A prospective, randomized, double-blind, placebo-controlled, multic enter trial. Setting: ICUs at three academic tertiary care medical centers. Patients: A total of 160 patients who were admitted to the ICU and met the eligibility criteria were enrolled in the study (80 into the rHuEPO group; 80 into the placebo group). Interventions: Patients were randomized to receive either rHuEPO or placebo . The study drug (300 units/kg of rHuEPO or placebo) was administered by su bcutaneous injection beginning ICU day 3 and continuing daily for a total o f 5 days (until ICU day 7). The subsequent dosing schedule was every other day to achieve a hematocrit (Hct) concentration of >38%, The study drug was given for a minimum of 2 wks or until ICU discharge (for subjects with ICU lengths of stay >2 wks) up to a total of 6 wks (42 days) postrandomization . Measurements and Main Results: The cumulative number of units of RBCs trans fused was significantly less in the rHuEPO group than in the placebo group (p < .002, Kolmogorov-Smirnov test). The rHuEPO group was transfused with a total of 166 units of RBCs vs. 305 units of RBCs transfused in the placebo group. The final Hct concentration of the rHuEPO patients was significantl y greater than the final Hct concentration of placebo patients (35.1 +/- 5. 6 vs. 31.6 +/- 4.1; p < .01, respectively). A total of 45% of patients in t he rHuEPO group received a blood transfusion between days 8 and 42 or died before study day 42 compared with 55% of patients in the placebo group (rel ative risk, 0.8; 95% confidence interval, 0.6, 1,1), There were no signific ant differences between the two groups either in mortality or in the freque ncy of adverse events. Conclusions: The administration of rHuEPO to critically ill patients is eff ective in raising their Hct concentrations and in reducing the total number of units of RBCs they require.