Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis

Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. NL9049 (Dutch Trial Register), registered on 16 November 2020.

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Publication Details

Journal
Critical Care
Published
2025-12-18
DOI
https://doi.org/10.1186/s13054-025-05745-5
Citations
2
Primary Topic
Blood transfusion and management
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article
Field-Weighted Citation Impact
1.55

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article

Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis

Eylem Tunçay, Eman Younes, Selin Eyüpoğlu, Theodoros Aslanidis et al.
2 citations
Critical Care
Blood transfusion and management
1.55
article

Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis

Eylem Tunçay, Eman Younes, Selin Eyüpoğlu, Theodoros Aslanidis, Tarikul Hamid, Swapna Vijayakumaran, Jens Meier, Kadarapura Nanjundaiah Gopalakrishna, Nathan D. Nielsen, Claudia van den Oord, John Santamaria, Florian Reizine, Canan Uğur Yılmaz, Mafalda Mourisco, Paul Power, Ahmad Buimsaedah, Jay S. Raval, Charles Michael Gibson, Matthew Mac Partlin, Andrej Markota, Carolina Ferrer, Nicolas Girerd, Dariusz Onichimowski, Eleftherios Papadakis, Nihan Yapící, Jimmy Schenk, Thomas Scheeren, Stéphan Ehrmann, David Bowen, David Brewster, Halide Oğuş, Husayn Aween, Eline A. Vlot, Alexis Tabah, Robert Bojčić, Athina Lavrentieva, Marco Covotta, Seyfi Kartal, Alexis Poole, Joana Fernandes, Zubair Hasan, Merijn C. Reuland, Clementine Bostantzoglou, Ross Freebairn, Stephanie O’Connor, Aynur Camkıran Fırat, Aihab Benamwor, Jan Bakker, Tony Trapani, Danai Theodoulou, Agustín Díaz-Álvarez, Rachel Baumber, Sheila Nainan Myatra, Kubilay İşsever, Antonella Cotoia, Cenk İndelen, Brendan Sloan, Ryszard Gawda, Jan Benes, Henrik Rajala, Vojislava Nešković, Elier Carrera González, Gamze Küçükosman, Karina Brady, Raman Azad, Nigar Ertuğrul Örüç, Raquel Ferrandis, Tom Lawton, Matej Podbregar, Michaël Piagnerelli, Elisha Turner, Nilgün Kavrut Öztürk, Tomislav Mirković, Deepak Jeswani, Emine Kutahya, Xavier Chapalain, Craig French, Amber‐Louise Poulter, Kévin Duarte, Khalil Tamoos, Umut Sabri Kasapoğlu, Rebeca González- Celdrán, Pierre Garçon, Ahmad Bouhuwaish, Petra Forjan, Richard McAllister, Cécile Aubron, Bruno Lévy, Pauline Cailliez, Lionel Haentjens, Lene Russell, Christian Sylvest Meyhoff, Amol Hartalkar, Marta Szczukocka, Višnja Ikić, Filippo Sanfilippo, Marwa Biala, Jayson Clarke, Muhammed Elhadi, Mehmet Tevfik Yavuz, Juan V. Llau, Giorgos Marinakis, Diana Cuesta, Ayça Sultan Şahin, Jamie Patel, Ana Marta Mota, Akshay Shah, Jolie Bruno, Slavica Kvolik, Hergen Buscher, Jonathan H. Chen, Jakub Mazur, Magdalena Wujtewicz, Ary Serpa Neto, İskender Kara, Łukasz Krzych, Ruwan Suwandarathne, Antoine Kimmoun, Mark G. Carpenter, Athanasios Prekates, Ourania Mousafiri, Jorinde Raasveld, Marcus D. Lancé, Prashanti Marella, Konstantina Triantafyllopoulou, Paraskevi Tripolitsioti, Paweł Zatorski, Maciej Molsa, Erica M. Wood, Morten H. Bestle, Eman Abdulwahed, Paul Secombe, Mohamed Elbahnasawy, Vasiliki Chantziara, Georgia Micha, Osman Ekinci, Yelíz Bílír, Carmen Andrea Pfortmueller, Mahmut Alp Karahan, Evren Şentürk, Olena Khomenko, Mehmet Yılmaz, S. Henman, Ioannis Georgakas, I Satinský, Alisa M. Higgins, Michael C. Reade, Rima Song, Gaëlle Corno, M.J. Colomina, Ökkeş Hakan Miniksar, Ayfer Kaya Gök, Stavros Aloizos, Akram Khan, Alya Abdalhadi, Yoann Launey, Aarne Feldheiser, Sofia Nikolakopoulou, Pierre-Yves Egreteau, Luke Newey, Mohamed Alsori, Katherine Elizabeth Triplett, Γεώργιος Παπαθανάκος, Betül Başaran, Jan Zatloukal, Harm‐Jan de Grooth, Alexander P. J. Vlaar, Yahya Yıldız, Natalie Johansen, Christina Whitehead, Senay Goksu, Bushray Almiqlash, Venkat Raman Kola, Hernan Aguirre‐Bermeo, Alain Roman, Tina Tomić Mahečić, Maria Cronhjort, Michiel Erkamp, Paweł Twardowski, Md Motiul Islam, Asu Özgültekin, Alev Öztaş, Lidija Kuznecova-Keppel Hesselink, Graham Reece, A. Gómez‐Luque, Injamam Ull Haque, Alexandre Mebazaa, S. Kannan, Mariachiara Ippolito, Charlène Le Moal, Kemal Tolga Saraçoğlu, Guillaume Carteaux, Sanne de Bruin, Jean Reignier, Ata Mahmoodpoor, Carlos Ferrando, Najat Shaban Ben Hasan, Nicole P. Juffermans, Maurizio Cecconi, Chrysanthi Sklavou, Andrew W. J. Flint, Diana Adrião, Eddy Lebas, Florence Boissier, Gerardo Aguilar, Marcella C.A. Müller, Guillaume Baudry, Ghannam Abdelilah, Rema Hassan Mohamed Otman, Evangelia Dikoudi, Mohamed Fathi Al Gharyani, Mawadda Altair, Hibah Bileid Bakeer, Omlez Mohammed Alkeelani, Marek Maslicki, Tomaž Savli, Disa Blomstrand, Hazem Alwagih, Martin Duksa, Lukáš Bílek, Heinert Enmanuel Gonzabay-Campos, Silia Karaouli, Asma Abubakr Saleh Alkamkhe, Azah Mukhtar Omar Affat, Emelie Risberg, Evangelia Tsika, Ehab Ishteiwy, Stefan van Wonderen, Erken Sayan, James Herdman, Osama Akrama, Ana Maria Diaz-Medina, Natalie Layous, Victor van Bochove, Hebtallah Benzarti, Hajer Abdalla Mohammed Hwili, Verónica Llumiquinga, Marwah Abdulkhaleq, Natalija Krope, Yan Chen, Alexandra Paula, Ayşe Özcan, D. James Cooper, Lixian Chen, Louise Ma, Agnieszka Wieczorek, Teresa Guimarães, Jonathan Barrett, Anna Włudarczyk, Murat Acarel, Darshana Rathod, Elisabete Coelho, Meredith Young, Vincenzo Pota, Anil Hormis, Manual Quintana‐Diaz, Sandra Peake, Kazimir Juričić, Rachael Parke, Hüseyin Arıkan, Konstantinos Tsakalis, Jan Mehrtens, Alan Rashid, Mary Rose Sol Cruz, Vishwanath Biradar, Mohan Gurjar, A Palaiologou, Sophia Pouriki, Marko Kmet, Chris Acott, Bengü Gülhan Aydın, Dinesh Parmar, Richard Innes, Elizabeta Mušič, Lauren Sutherland, Richard Moore, Francisco Hidalgo, Guido Janssen, Najwa Abdelrahim, Marcin Kubiak, Igor Mark, Caroline M. Schaap, Agnieszka Misiewska- Kaczur, Basar ErAuthorNameanli
article en
2 citations

Abstract

Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. NL9049 (Dutch Trial Register), registered on 16 November 2020.

Critical CareVol. 29(1)
University of Bern (CH), University of Copenhagen (DK), Military Medical Academy (RS), University Medical Center Groningen (NL), University Hospital Centre Zagreb (HR), Inserm (FR), Sanjay Gandhi Post Graduate Institute of Medical Sciences (IN), Université de Bretagne Occidentale (FR), Pontificia Universidad Católica de Chile (CL), University of New Mexico (US), University of Opole (PL), University of Campania "Luigi Vanvitelli" (IT), Promega (United States) (US), Homi Bhabha National Institute (IN), National and Kapodistrian University of Athens (GR), Université Paris Cité (FR), Charles University (CZ), University of Tripoli (LY), Aga Khan University Hospital Nairobi (KE), Tata Memorial Hospital (IN), Hospital Universitario La Paz (ES), University Hospital of Bern (CH), Interbalkan Medical Center (GR), Ljubljana University Medical Centre (SI), Erasmus MC (NL), Copenhagen University Hospital (DK), Gentofte Hospital (DK), Rigshospitalet (DK), Karolinska Institutet (SE), University of Oxford (GB), Australian and New Zealand Intensive Care Society (AU), Unidade Local de Saúde de Entre Douro e Vouga (PT), Stockholm South General Hospital (SE), Assistance Publique – Hôpitaux de Paris (FR), Hospital Vicente Corral Moscoso (EC), Centre Hospitalier Régional et Universitaire de Nancy (FR), Aga Khan University Nairobi (KE), University Hospital Plzen (CZ), Hôpital Lariboisière (FR), Kepler Universitätsklinikum (AT), Hospital Universitario Doctor Peset (ES), Sağlık Bilimleri Üniversitesi (TR), Kliniken Essen-Mitte (DE), Amsterdam University Medical Centers (NL), IRCCS Humanitas Research Hospital (IT), Sotiria General Hospital (GR), Défaillance Cardiovasculaire Aiguë et Chronique, Monash University (AU), University of Amsterdam (NL), Université de Lorraine (FR)
Monash University, European Society of Intensive Care Medicine, Medical Research Council, National Health and Medical Research Council
Openalex Percentile: Top 14%
Blood transfusion and management
1.55
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