Effects of hemoglobin transfusion thresholds on clinical outcomes in sepsis-related ARDS: A retrospective cohort analysis utilizing the MIMIC-IV database

Sepsis, a systemic pathological reaction induced by infection, is a major contributor to acute respiratory distress syndrome (ARDS) in intensive care units (ICUs). This retrospective cohort study aimed to evaluate the impact of hemoglobin transfusion thresholds on clinical outcomes in patients with sepsis-related ARDS using the medical information mart for intensive care IV database. Patients were categorized into a high-threshold group (hemoglobin ≥ 7 g/dL) and a low-threshold group (hemoglobin < 7 g/dL) based on the lowest hemoglobin concentration within 24 hours before transfusion. The results showed no significant differences in overall mortality during hospitalization, in the ICU, or at 30, 60, and 90 days between the high- and low-transfusion threshold groups. The duration of ICU stay was comparable in both groups; however, the total hospital stay was longer in the low-threshold cohort. Stratified analysis showed that changing the transfusion thresholds did not significantly affect the prognosis of people with ARDS stage 1. However, in ARDS stage 2, the high-threshold group showed a trend toward lower in-hospital and ICU mortality rates, although the difference was not statistically significant. This study suggests that a low-transfusion threshold does not adversely affect sepsis-related ARDS patient mortality, but the potential benefits of blood transfusion need to be balanced against the risk of prolonged hospitalization.