Long-term Survival in the Intensive Care Unit After Erythrocyte Blood Transfusion

Background Erythrocyte blood transfusions are commonly used in intensive care units, yet little is known about their effects on long-term survival. Objective To determine the effect of erythrocyte blood transfusion in intensive care units on long-term survival. Methods Retrospective analysis of a prospectively collected database of 2213 patients admitted January 27, 2001, to April 30, 2002, to the cardiac, burn, neurological-neurosurgical, and combined medical-surgical intensive care units in a tertiary care, university-affiliated, urban medical center. Further analysis was done on a case-control subgroup 9n = 556) formed by matching scores on the Acute Physiology and Chronic Health Evaluation 9APACHE) II and propensity scores. Results Although transfusion was univariably associated with increased risk of death at all 3 times 90-30, 31-180, and > 180 days after admission to the unit), multivariable adjustment with Cox modeling showed that transfusion had no association with mortality for the first 2 intervals 90-30 and 31-180 days), but was associated with a 25% lower risk of death 9hazard ratio, 0.75; 95% confidence interval, 0.57-0.99; P = .04) in patients who survived at least 180 days after admission to the unit. In the case-control patients, after correction for APACHE II risk of death and propensity to receive a transfusion, transfusion had no association with mortality for the first 2 intervals, but was associated with 29% lowered risk of death 9hazard ratio, 0.71; 95% confidence interval, 0.50-0.99; P =. 046). Conclusion Blood transfusion was associated with a decreased risk of late (> 180 days) death in intensive care patients. 9American Journal of Critical Care. 2009; 18:124-132)