Anemia and red blood cell transfusion in critically ill cardiac patients

Du Pont-Thibodeau, Geneviève; Harrington, Karen; Lacroix, Jacques

doi:10.1186/2110-5820-4-16

Annals of Intensive Care

Table 2 Red blood cell (RBC) transfusions and outcomes in cardiac patients: observational studies ^a

From: Anemia and red blood cell transfusion in critically ill cardiac patients

	Health problem	Patients	Risk^c
Outcome, first author, year^b		(n)	(95% CI)	P- value
Outcome: mortality in adults
Mortality, Alexander, 2008 [35]	ACS	44,242	OR: 3.2 (2.9 to 3.6)
	ACS and Hct ≤ 24%		aOR: 0.68 (0.45 to 1.02)
	ACS and Hct = 24 to 27%		aOR: 1.01 (0.79 to 1.30)
	ACS and Hct = 27 to 30%		aOR: 1.18 (0.92 to 1.50)
	ACS and Hct > 30%		aOR: 3.47 (2.30 to 5.23)
Mortality, Aronson, 2008 [36]	AMI	2,358	aHR: 0.13 (0.03 to 0.65)^d,e	0.013
			aHR: 2.2 (1.5 to 3.3)^d,f	< 0.0001
Mortality, Jani, 2007 [37]	AMI	4,623	aOR: 2.02 (1.47 to 2.79)	< 0.0001
			RR: 4.83 (3.81 to 6.12)^d
Mortality, Jolicœur, 2009 [38]	AMI	5,188	RR: 6.38 (4.88 to 8.34)
		5,532	aHR: 2.16 (1.20 to 3.88)	< 0.0001
		5,188	RR: 6.38 (4.88 to 8.34)^d
Mortality, Koch, 2006 [39]	CABG	5,814	OR: 1.77 (1.67 to 1.87)	< 0.0001
Mortality, Murphy, 2007 [40]	Cardiac surgery (UK)	8,518	HR: 6.69 (3.66 to 15.1)	< 0.05
Mortality, Nikolsky, 2009 [41]	AMI	2,060	HR: 4.71 (1.97 to 11.36)
			RR: 2.92 (1.62 to 5.24)^d
Mortality, Pattakos, 2012 [42]	Cardiac surgery	644	95% versus 89%	0.007
Mortality, Rao, 2004 [43]	ACS	24,112	aHR: 3.94 (3.26 to 4.75)	< 0.05
			RR: 2.60 (2.22 to 3.03)^d	< 0.05
Mortality, Shehata, 2012 [19]	CABG	2,102	OR: 0.44 (0.32 to 14.1)	NS
Mortality, Shishehbor, 2009 [44]	AMI	3,575	aHR: 3.89 (2.66 to 5.68)	< 0.001
			RR: 1.30 (0.90 to 1.88)^d	< 0.001
Mortality, Singla, 2007 [45]	AMI	370	RR: 2.36 (1.49 to 3.76)^d
Mortality, Wu, 2001, [46]	AMI	78,974	RR: 2.51 (2.42 to 2.61)^d,g	< 0.05
Mortality, Yang, 2005 [47]	AMI	85,111	aOR: 1.67 (1.48 to 1.88)	< 0.05
			RR: 3.03 (2.85 to 3.21)^d	< 0.05
Outcomes: myocardial infarction or ischemic events^h in adults
AMI, Jani, 2007 [37]	AMI	4,623	RR: 1.19 (0.82 to 1.74)^d
AMI, Jolicœur, 2009 [38]	AMI	5,188	RR: 3.05 (1.85 to 5.04)^d
IE^h, Murphy, 2007 [40]	Cardiac surgery (UK)	8,518	aOR: 3.35 (2.68 to 4.35)^c	< 0.05
AMI, Nikolsky, 2009 [41]	AMI	2,060	RR: 3.28 (1.44 to 7.49)^d
AMI, Pattakos, 2012 [42]	Cardiac surgery	644	2.8% versus 0.31%	< 0.01
AMI + death, Rao, 2004 [43]	ACS	2,401	HR: 3.08 (2.84 to 3.35)^d	< 0.05
AMI, Shishehbor, 2009 [44]	ACS	3,575	aHR : 3.44	< 0.001
AMI + death, Singla, 2007 [45]	AMI	370	aOR: 2.57 (1.41 to 4.69)	< 0.001
			RR: 2.10 (0.83 to 5.30)^d
AMI, Yang, 2005 [47]	AMI	85,111	aOR: 0.95 (0.83 to 1.09)^d	< 0.05
Outcomes in children	Health problem	Children	Risk ^c	P -value
LMV (days), 2011 [48]	Cardiac surgery	270	HR: 0.71 (0.54 to 0.92)	0.009
LMV (days), 2013 [49]	Cardiac surgery	335	HR: 2.6 (2.0 to 3.4)	< 0.001
PICU LOS (days), 2013 [49]	Cardiac surgery	335	LOS: 8 ± 0.9 versus 3.5 ± 2	< 0.001
Hospital LOS, 2011 [24]	Cardiac surgery	802	aHR: 0.65 (0.49 to 0.87)	< 0.001
Wound infection, 2010 [50]	Cardiac surgery	216	aOR: 7.87 (1.63 to 37.92)	< 0.001

ACS: acute coronary syndrome; aHR: adjusted HR; AMI: acute myocardial infarction; aOR: adjusted OR; CABG: coronary artery bypass graft; card surg: cardiac surgery; CI: confidence interval; Hct: hematocrit; HR: hazard ratio; IE: ischemic events; LMV: length of MV; LOS: length of stay; MI: myocardial infarction; MV: mechanical ventilation; OR: odds ratio; PICU: pediatric intensive care unit; RBC: red blood cell; NS: not significant; RCT: randomized controlled trial; UK: United Kingdom.
^aStudies on the relationship between the length of storage of RBC units and outcomes of transfused cardiac patients are excluded from this table.
^bYear of publication.
^cTransfused patients versus no RBC transfusion or restricted RBC transfusion strategy.
^dChatterjee et al. [51] completed a systematic review that included the studies marked by^d in this table, plus a small RCT conducted by Cooper et al. [52]. Overall, the risk ratio of death in transfused patients versus controls was 2.91 (95% confidence interval (CI): 2.46 to 3.44), but there was a very significant heterogeneity (I² = 92%).
^ePre-transfusion hemoglobin concentration ≤ 80 g/L.
^fPre-transfusion hemoglobin concentration > 80 g/L.
^gThe study by Wu et al. [46] enrolled patients ≥ 65 years of age with AMI. RBC transfusion was associated with a reduction in 30-day mortality if hematocrit < 24% (aOR = 0.22; 95% CI: 0.11 to 0.45) or between 30% and 33% (aOR = 0.69; 95% CI: 0.53 to 0.89), but the risk of mortality was not increased in patients with a hematocrit > 33% who received RBC transfusion.
^hIschemic events: myocardial infarction, stroke, renal impairment, or failure.

Back to article page