Kim Tae Sung, Cho Yongil, Choi Hyuk Joong, Park Joonbum, Kim Wonhee, Ahn Chiwon, Kim Joon Young
Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea.
Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea.
Acute Crit Care. 2024 Nov;39(4):517-525. doi: 10.4266/acc.2024.00577. Epub 2024 Nov 5.
Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.
This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.
Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.
Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.
红细胞（RBCs）是一种有限的资源，必须考虑输血的不良反应。已经开展了多项关于输血阈值的随机对照试验，从而确立了限制性输血策略。本研究旨在调查重症患者红细胞输血的现状。
本队列研究在韩国的五所大学医院进行。从2022年12月18日至2023年11月30日，纳入了307名通过急诊科入住重症监护病房的非创伤性贫血患者。我们确定了患者是否接受红细胞输血、输血触发因素以及临床结果。
在154名接受红细胞输血的患者中，71名（46.1%）血红蛋白水平达到或高于7。除血红蛋白水平外的触发因素包括75名患者（48.7%）乳酸水平升高、47名患者（30.5%）心动过速以及46名患者（29.9%）低血压。与未输血组相比，输血组的28天死亡率没有显著降低（21.4%对26.8%，P = 0.288）。两组在重症监护病房和医院的住院时间或出院生存率方面没有差异。在各个亚组中，预后呈现相同的模式。
尽管大量红细胞输血与限制性策略相悖，但重症患者的预后没有显著差异。为了尽量减少不必要的红细胞输血，需要推广输血指南并开展反映个体患者情况的输血标准研究。
