dc.contributor.author
Hunsicker, Oliver
dc.contributor.author
Materne, Lorenz
dc.contributor.author
Bünger, Victoria
dc.contributor.author
Krannich, Alexander
dc.contributor.author
Balzer, Felix
dc.contributor.author
Spies, Claudia
dc.contributor.author
Francis, Roland
dc.contributor.author
Weber-Carstens, Steffen
dc.contributor.author
Menk, Mario
dc.contributor.author
Graw, Jan Adrian
dc.date.accessioned
2022-07-25T08:20:28Z
dc.date.available
2022-07-25T08:20:28Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/35654
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-35368
dc.description.abstract
Background: Efficacy and safety of different hemoglobin thresholds for transfusion of red blood cells (RBCs) in adults with an acute respiratory distress syndrome (ARDS) are unknown. We therefore assessed the effect of two transfusion thresholds on short-term outcome in patients with ARDS.
Methods: Patients who received transfusions of RBCs were identified from a cohort of 1044 ARDS patients. After propensity score matching, patients transfused at a hemoglobin concentration of 8 g/dl or less (lower-threshold) were compared to patients transfused at a hemoglobin concentration of 10 g/dl or less (higher-threshold). The primary endpoint was 28-day mortality. Secondary endpoints included ECMO-free, ventilator-free, sedation-free, and organ dysfunction-free composites.
Measurements and main results: One hundred ninety-two patients were eligible for analysis of the matched cohort. Patients in the lower-threshold group had similar baseline characteristics and hemoglobin levels at ARDS onset but received fewer RBC units and had lower hemoglobin levels compared with the higher-threshold group during the course on the ICU (9.1 [IQR, 8.7-9.7] vs. 10.4 [10-11] g/dl, P < 0.001). There was no difference in 28-day mortality between the lower-threshold group compared with the higher-threshold group (hazard ratio, 0.94 [95%-CI, 0.59-1.48], P = 0.78). Within 28 days, 36.5% (95%-CI, 27.0-46.9) of the patients in the lower-threshold group compared with 39.5% (29.9-50.1) of the patients in the higher-threshold group had died. While there were no differences in ECMO-free, sedation-free, and organ dysfunction-free composites, the chance for successful weaning from mechanical ventilation within 28 days after ARDS onset was lower in the lower-threshold group (subdistribution hazard ratio, 0.36 [95%-CI, 0.15-0.86], P = 0.02).
Conclusions: Transfusion at a hemoglobin concentration of 8 g/dl, as compared with a hemoglobin concentration of 10 g/dl, was not associated with an increase in 28-day mortality in adults with ARDS. However, a transfusion at a hemoglobin concentration of 8 g/dl was associated with a lower chance for successful weaning from the ventilator during the first 28 days after ARDS onset.
Trial Registration: ClinicalTrials.gov NCT03871166.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
Red blood cells
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Lower versus higher hemoglobin threshold for transfusion in ARDS patients with and without ECMO
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.articlenumber
697
dcterms.bibliographicCitation.doi
10.1186/s13054-020-03405-4
dcterms.bibliographicCitation.journaltitle
Critical Care
dcterms.bibliographicCitation.number
1
dcterms.bibliographicCitation.originalpublishername
Springer Nature
dcterms.bibliographicCitation.volume
24
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.funding
Springer Nature DEAL
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
33327953
dcterms.isPartOf.eissn
1466-609X