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

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 months to 18 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. 3.2 +/-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.