October 9, 2014
Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock.
What was the research question?
Is a higher threshold of hemoglobin associated with a better outcome in patients with septic shock compared to a lower threshold?
How did they do it?
A multicenter, parallel-group trial in 32 general ICUs in Denmark, Sweden, Norway, and Finland.
1005 patients with septic shock and a hemoglobin concentration of 9 g/dL or less. Patients with active bleeding or acute coronary syndrome were excluded.
Randomized patients to a low transfusion threshold of 7 g/dL or a high transfusion threshold with hemoglobin level of 9 g/dL during the ICU stay.
The primary outcome measure was death by 90 days.
What did they find?
998 patients were analyzed.
90-day mortality was not significantly different between the low and the high threshold groups (43.0% vs. 45.0%; P=0.44).
No difference in ischemic events, severe adverse reactions, duration of vasopressors, mechanical ventilation, or length of stay.
Less median blood transfusion in the low threshold group compared to the high threshold group (1 vs 4; p<0.001), and the receipt of at least one unit of blood transfusion was significantly lower in the low threshold group (63.9% vs. 98.1%; p<0.001).
What does it mean?
90-day mortality rate was not different between the lower (7 g/dL) versus the higher (9 g/dL) hemoglobin transfusion threshold in patients with septic shock in the intensive care unit. A lower threshold tgroup was associated with less use of blood transfusion.
No need to transfuse blood unless the hemoglobin is less than 7 g/dL in septic patients who are not actively bleeding and not having acute coronary syndrome.