Third Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China.
Department of Intensive Care Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Sci Rep. 2024 Oct 10;14(1):23769. doi: 10.1038/s41598-024-75643-3.
Patients with chronic kidney disease (CKD) often have impaired immune function, making them more prone to infections that can lead to sepsis. The coexistence of these conditions can result in decreased hemoglobin levels and is associated with a higher mortality rate. To investigate whether the transfusion of red blood cells (RBCs) improves the prognosis of septic patients with concomitant CKD and to explore the indications for red blood cell transfusion. This retrospective cohort study utilizes data from the MIMIC-IV (v2.0) database. The study enrolled 6,604 patients with sepsis and concomitant CKD admitted to the Intensive Care Unit (ICU). Propensity score matching (PSM) was applied to adjust for confounding factors. Multivariate Cox regression analysis revealed an association between RBC transfusion and a decreased risk of 28-day mortality (HR: 0.61, 95% CI: 0.54-0.70, P < 0.001). Following a meticulous 1:1 propensity score matching analysis between the two cohorts, the matched population revealed a notable decrease in 28-day mortality within the RBC transfusion group (HR: 0.60, 95% CI: 0.51-0.71; P < 0.001). Additionally, we observed that a SOFA score ≥ 5, a Base Excess (BE) value < 3, and an estimated Glomerular Filtration Rate (eGFR) < 30 may be considered when evaluating the potential need for RBC transfusion. This study demonstrated an association between RBC transfusion and decreased 28-day mortality in patients with sepsis accompanied by CKD. The patient's BE value, SOFA score, and eGFR are crucial factors influencing the treatment outcome and should be considered when deciding on RBC transfusion.
患有慢性肾病 (CKD) 的患者通常免疫功能受损，更容易发生感染，从而导致败血症。这些情况的共存可能导致血红蛋白水平降低，并与更高的死亡率相关。本研究旨在探讨败血症合并 CKD 患者输注红细胞 (RBC) 是否改善预后，并探讨 RBC 输注的适应证。本回顾性队列研究利用了 MIMIC-IV (v2.0) 数据库的数据。研究纳入了 6604 名因败血症和合并 CKD 入住重症监护病房 (ICU) 的患者。采用倾向评分匹配 (PSM) 调整混杂因素。多变量 Cox 回归分析显示 RBC 输注与 28 天死亡率降低相关 (HR：0.61，95%CI：0.54-0.70，P<0.001)。在对两组进行了细致的 1:1 倾向评分匹配分析后，匹配人群中 RBC 输注组 28 天死亡率显著降低 (HR：0.60，95%CI：0.51-0.71；P<0.001)。此外，我们观察到在评估 RBC 输注的潜在需求时，可以考虑 SOFA 评分≥5、基础不足 (BE) 值<3 和估计肾小球滤过率 (eGFR)<30。本研究表明败血症合并 CKD 患者 RBC 输注与 28 天死亡率降低相关。患者的 BE 值、SOFA 评分和 eGFR 是影响治疗结果的关键因素，在决定 RBC 输注时应予以考虑。
