Red blood cell transfusion in critically ill children is independently associated with increased mortality

Martin C J Kneyber, Mohammed I Hersi, Jos W R Twisk, Dick G Markhorst, Frans B Plötz

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Abstract

OBJECTIVE: To test the hypothesis that RBC transfusion in critically ill children is independently associated with increased mortality and morbidity.

DESIGN: Retrospective, descriptive epidemiologic cohort study.

SETTING: Single-center experience of a nine-bed pediatric intensive care unit (PICU) facility.

PATIENTS: Critically ill children without ongoing active blood loss aged 0[Symbol: see text]months to 18[Symbol: see text]years, excluding prematurely born infants or patients after cardiothoracic surgery, and patients with chronic anemia.

INTERVENTIONS: None.

MEASUREMENTS AND RESULTS: Data of 295 consecutive patients was studied. Of these patients, 13.4% had a Hb concentration less than 9.6 g/dl. Sixty-seven (22.7%) of all patients were transfused, 39 only once. Transfused patients had a higher mortality (16.4 vs. 2.6%, p < 0.001). Mortality seemed related to the number of transfusion (p = 0.002) rather than the pre-transfusion Hb concentration (p = 0.10). Transfused patients required prolonged ventilatory support (11.1 +/- 1.8 vs. +/- 0.3 days, p < 0.001), infusion of vaso-active agents (8.2 +/- 1.8 vs. 2.8 +/- 0.6 days, p < 0.001) and PICU stay (13.0 +/- 1.8 vs. 3.2 +/- 0.2 days, p < 0.001). After multivariate analysis adjusting for age, PIM probability of death, mean TISS-28 score during the first 48 h, post-operative admission, diagnosis of sepsis or trauma or malignancy, pre-transfusion Hb concentration, and RBC transfusion remained independently associated with mortality and morbidity.

CONCLUSIONS: RBC transfusion in critically ill children is independently associated with increased mortality and prolonged duration of mechanical ventilation, prolonged infusion of vaso-active agents and prolonged PICU stay.

Original languageEnglish
Pages (from-to)1414-1422
Number of pages9
JournalIntensive Care Medicine
Volume33
Issue number8
DOIs
Publication statusPublished - Aug-2007

Keywords

  • Cause of Death
  • Child
  • Child, Preschool
  • Cohort Studies
  • Critical Illness
  • Erythrocyte Transfusion/adverse effects
  • Female
  • Hospital Mortality/trends
  • Humans
  • Intensive Care Units, Pediatric
  • Length of Stay
  • Male
  • Netherlands
  • Observation
  • Outcome Assessment (Health Care)
  • Proportional Hazards Models
  • Retrospective Studies

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