Permpikul Chairat, Tanksinmankhong Jakpanee, Tongyoo Surat, Naorungroj Thummaporn, Viarasilpa Tanuwong, Karaketklang Khemajira
Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand.
Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Intern Emerg Med. 2025 Apr;20(3):829-839. doi: 10.1007/s11739-025-03889-4. Epub 2025 Feb 20.
Transfusions of red blood cells (RBCs) are crucial for improving tissue oxygenation in anemic patients with sepsis. Nevertheless, the debate continues over the ideal hemoglobin level for transfusions. This study aimed to assess the impact of different hemoglobin levels on the outcomes of patients with sepsis who received transfusions. This retrospective analysis included adult patients with sepsis treated in the general medical ward and intensive care unit at a University affiliate hospital. Patients needing RBC transfusions were included. The primary outcome was the 28-day mortality rate. From March 2018 to January 2022, 806 patients were studied. Of these, 480 (59.6%) were transfused at hemoglobin levels of 7-9 g/dL ("liberal group"), while 326 (40.4%) received RBC transfusions when their hemoglobin was < 7 g/dL ("restrictive group"). Mean hemoglobin levels at transfusion were 8.1 ± 0.8 g/dL and 6.3 ± 0.8 g/dL for each group, respectively(P < 0.001). On day 28, the liberal group had a mortality rate of 51.2% (246 patients), compared to 59.2% (193 patients) in the restrictive group (Odds ratio [OR] 0.88, 95% confidence interval [CI] 0.79-0.98, P = 0.031). Adjusted comparisons showed 46.8% mortality in the liberal group (141/301patients) versus 59.3% in the restrictive group (178/300patients) at 28 days (OR 0.78, 95% CI 0.66-0.92, P = 0.002). Multivariate analysis revealed transfusion at hemoglobin 7-9 g/dL as an independent variable linked to lower 28-day mortality (OR 0.70, 95% CI 0.49-0.99, P = 0.042). Other factors correlated with 28-day mortality were platelet counts ≤ 150 × 10/µL, albumin ≤ 2.5 g/dL, shock, mechanical ventilation, and renal replacement therapy. This retrospective study suggests that RBC transfusion at hemoglobin levels of 7-9 g/dL associates with lower 28-day mortality in sepsis patients compared to transfusion at hemoglobin levels below 7 g/dL.Clinical trial registrationThe study was registered with the Thai Clinical Trials Registry (identification number TCTR20231003003). ( https://www.thaiclinicaltrials.org/show/TCTR20231003003 ).
输注红细胞（RBC）对于改善脓毒症贫血患者的组织氧合至关重要。然而，关于输血的理想血红蛋白水平的争论仍在继续。本研究旨在评估不同血红蛋白水平对接受输血的脓毒症患者结局的影响。这项回顾性分析纳入了在一所大学附属医院的普通内科病房和重症监护病房接受治疗的成年脓毒症患者。纳入需要输注红细胞的患者。主要结局是28天死亡率。2018年3月至2022年1月，共研究了806例患者。其中，480例（59.6%）在血红蛋白水平为7 - 9 g/dL时接受输血（“宽松组”），而326例（40.4%）在血红蛋白<7 g/dL时接受红细胞输血（“严格组”）。每组输血时的平均血红蛋白水平分别为8.1±0.8 g/dL和6.3±0.8 g/dL（P<0.001）。在第28天，宽松组的死亡率为51.2%（246例患者），而严格组为59.2%（193例患者）（优势比[OR] 0.88，95%置信区间[CI] 0.79 - 0.98，P = 0.031）。校正后的比较显示，在第28天，宽松组的死亡率为46.8%（141/301例患者），而严格组为59.3%（178/300例患者）（OR 0.78，95% CI 0.66 - 0.92，P = 0.002）。多变量分析显示，血红蛋白7 - 9 g/dL时输血是与较低28天死亡率相关的独立变量（OR 0.70，95% CI 0.49 - 0.99，P = 0.042）。与28天死亡率相关的其他因素包括血小板计数≤150×10/µL、白蛋白≤2.5 g/dL、休克、机械通气和肾脏替代治疗。这项回顾性研究表明，与血红蛋白水平低于7 g/dL时输血相比，血红蛋白水平为7 - 9 g/dL时输注红细胞与脓毒症患者较低的28天死亡率相关。临床试验注册该研究已在泰国临床试验注册中心注册（注册号TCTR20231003003）。（https://www.thaiclinicaltrials.org/show/TCTR20231003003）
