SLR - June 2011 - James Johnston (1)
Reference: Taylor, R., Manganaro, L., O’Brien, J., et al. (2002). Impact of allogenic packed red blood cell transfusion on nosocomial infection relates in the critically ill patient. Critical Care Medicine. Vol. 30 No. 10.
Scientific Literature Review
Reviewed by: James Johnston, DPM
Residency Program: DVA San Francisco
Podiatric Relevance:
Podiatric surgeons frequently treat patients with degrees of vascular and medical comorbidities. Critical criteria for blood transfusions (Hct 10 and Hgb 30) vary from practitioner to practitioner. This article demonstrates the direct relationship of an increase in nosocomial infections (NI) rates in the critically ill patient. Providing a cautionary approach to transfusion in a asymptomatic patient with less than ideal Hct and Hgb
Methods:
Data as collected from 1,717 patients admitted at St. John’s Mercy Medical Center from October 1, 1998-August 31, 2000. NI rates were compared among three groups: the entire cohort, the transfusion group, and the non-transfusion group. Patients were included in the transfusion group if they received one or more units of PRBC. Patients were stratified for age, gender and probability of survival. Mortality was defined as death occurring before hospital discharge.
Results:
The mortality rate for the entire cohort was 13.6%. The transfusion group mortality rate was 24.3% while the non-transfusion group was recorded at 10.2% (p<0001). The NI rate for the entire cohort was 5.94%. The NI for transfusion ground (n=416) was 15.38% and for the non-transfusion group (1301) was 2.92% (p <.005). PRBC transfusion was related to the occurrence of NI and there was a dose-response pattern. The greater the number of PRBC units given the greater the chance of infection by a factor of 1.5% (p<.0001). Length of hospital stay was also longer within the transfusion population. Age had no statistically significant increase in rates of NI with or without transfusion.
Conclusions:
In this study, PRBC transfusion was closely associated with NI. This association has been previously reported in other medical disciplines. Mortality rates were significantly increased (p<.0001) in transfused patient compared with non-transfused patients. The more blood used, the higher the rate of NI was found and increased the length of hospitalization. Many questions related to anemia, blood transfusions, immunosuppression and NI in critically ill patients remain to be answered.