Effect of different blood transfusion threshold on the prognosis of elderly patients with anemia in intensive care unit
10.13303/j.cjbt.issn.1004-549x.2025.06.006
- VernacularTitle:不同输血启动阈值对高龄重症监护病房贫血患者预后的影响
- Author:
Feihuan HU
1
;
Heng YANG
2
;
Pushan ZHANG
1
;
Jun LI
1
;
Hanshen YE
1
Author Information
1. Department of Blood Transfusion, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
2. Department of Blood Transfusion, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Publication Type:Journal Article
- Keywords:
elderly intensive care;
restrictive blood transfusion;
liberal blood transfusion;
blood transfusion strategy;
clinical prognosis
- From:
Chinese Journal of Blood Transfusion
2025;38(6):782-787
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the clinical effect of blood transfusion treatment in elderly critically ill patients under different blood transfusion initiation thresholds. Methods: A total of 144 elderly critically ill patients aged >70 years who underwent red blood cell transfusion in the elderly intensive care unit (ICU) of our hospital from January 2021 to January 2023 were included. According to different blood transfusion initiation thresholds, the patients were divided into restrictive blood transfusion group (n=77, Hb<70 g/L before blood transfusion) and liberal blood transfusion group (n=67, Hb 70-100 g/L before blood transfusion). Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, estimated mortality and general data collection were performed when the two groups of patients entered the ICU. Blood transfusion details of these patients in the ICU were collected and documented, including pre-transfusion Hb levels, volume and number of red blood cell transfusion, and post- transfusion Hb levels. Propensity score matching (PSM) was used to match the baseline data of the two groups of patients, and the clinical outcomes were compared and analyzed after matching. Results: After PSM matching, 52 pairs of patients were successfully matched. The matched restrictive and liberal transfusion groups showed comparable characterists, including age, APACHE Ⅱ score, the number of cases with APACHE Ⅱ score >20, estimated mortality, incidence of comorbidities and primary diseases (P>0.05). The number of red blood cell transfusions and transfusion volume (U) in the ICU of the two groups were 7.77±4.73 vs 12.19±10.41, 11.64±7.65 vs 19.14±16.14 (all P<0.05), and the Hb levels (g/L) before and after red blood cell transfusion in the ICU was 59.92±5.98 vs 77.44±8.60,77.88±17.21 vs 87.56±15.23 (all P<0.05). In terms of clinical outcomes, there was no significant difference between the two groups (all P>0.05): ICU length of stay (d) 39.56±36.80 vs 40.10±49.29, three-week mortality rate (%) 21.2 vs 21.2, in-hospital mortality rate (%) 46.2 vs 53.9, mortality rate in subgroup with APACHE Ⅱ score ≤ 20 (%) 11.5 vs 1.9, the incidence of severe infection (%) 78.8 vs 73.1, the incidence of heart failure (%) 57.7 vs 44.2, and the incidence of pulmonary edema (%) 26.9 vs 19.2. Conclusion: Elderly ICU patients can tolerate lower blood transfusion thresholds. Therefore, the restrictive transfusion strategy can reduce the total amount of blood transfusion, save valuable blood resources, and achieve the same blood transfusion effect as the liberal transfusion strategy.
