Outcomes Associated With Early RBC Transfusion in Pediatric Severe Sepsis: A Propensity-Adjusted Multicenter Cohort Study

Jennifer A. Muszynski*, Russell Banks, Ron W. Reeder, Mark W. Hall, Robert A. Berg, Athena Zuppa, Thomas P. Shanley, Timothy T. Cornell, Christopher J.L. Newth, Murray M. Pollack, David Wessel, Allan Doctor, John C. Lin, Rick E. Harrison, Kathleen L. Meert, J. Michael Dean, Richard Holubkov, Joseph A. Carcillo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background:Little is known about the epidemiology of and outcomes related to red blood cell (RBC) transfusion in septic children across multiple centers. We performed propensity-adjusted secondary analyses of the Biomarker Phenotyping of Pediatric Sepsis and Multiple Organ Failure (PHENOMS) study to test the hypothesis that early RBC transfusion is associated with fewer organ failure-free days in pediatric severe sepsis.Methods:Four hundred one children were enrolled in the parent study. Children were excluded from these analyses if they received extracorporeal membrane oxygenation (n = 22) or died (n = 1) before sepsis day 2. Propensity-adjusted analyses compared children who received RBC transfusion on or before sepsis day 2 (early RBC transfusion) with those who did not. Logistic regression was used to model the propensity to receive early RBC transfusion. A weighted cohort was constructed using stabilized inverse probability of treatment weights. Variables in the weighted cohort with absolute standardized differences >0.15 were added to final multivariable models.Results:Fifty percent of children received at least one RBC transfusion. The majority (68%) of first transfusions were on or before sepsis day 2. Early RBC transfusion was not independently associated with organ failure-free (-0.34 [95%CI: -2, 1.3] days) or PICU-free days (-0.63 [-2.3, 1.1]), but was associated with the secondary outcome of higher mortality (aOR 2.9 [1.1, 7.9]).Conclusions:RBC transfusion is common in pediatric severe sepsis and may be associated with adverse outcomes. Future studies are needed to clarify these associations, to understand patient-specific transfusion risks, and to develop more precise transfusion strategies.

Original languageEnglish (US)
Pages (from-to)88-94
Number of pages7
JournalShock
Volume57
Issue number1
DOIs
StatePublished - Jan 1 2022

Funding

This project is supported, in part, by grant R01GM108618 (Dr Carcillo) from the National Institutes of General Medical Sciences, by K08HL123925 (Dr Muszynski) from the National Heart Lung and Blood Institute, by 5U01HD04993410S1 from the Eunice Kennedy Shriver National Institutes of Child Health and Development, National Institutes of Health, Department of Health and Human Services and the following cooperative agreements: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114, and U01HD049934.

Keywords

  • Blood transfusion
  • multiple organ failure
  • pediatric
  • sepsis

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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