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October 9, 2014

Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock.

Mazen Kherallah

Summarized by: 

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.


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