Study Reveals Link Between RBC Transfusion and Reduced Mortality in Septic Patients with CKD

The findings indicate that a patient's base excess (BE) value, Sequential Organ Failure Assessment (SOFA) score, and estimated glomerular filtration rate (eGFR) play vital roles in determining treatment outcomes and should be factored into decisions regarding RBC transfusion.

Sepsis is a life-threatening response to infection that often complicates the management of patients with chronic kidney disease. CKD patients frequently experience compromised immune function, increasing their susceptibility to infections that can trigger sepsis. The presence of both conditions can lead to lower hemoglobin levels and is linked to a higher mortality rate.

Against the above background, Xingxing Hu, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China, and colleagues aimed to examine whether RBC transfusions enhance the outcomes of septic patients with concurrent CKD and to assess the criteria for administering RBC transfusions.

For this purpose, the researchers conducted a retrospective cohort study using data from the MIMIC-IV (v2.0) database. The study included 6,604 patients with sepsis and concurrent chronic kidney disease who were admitted to the Intensive Care Unit (ICU). Propensity score matching (PSM) was employed to account for confounding variables.

The study led to the following findings:

• Multivariate Cox regression analysis revealed an association between RBC transfusion and a decreased risk of 28-day mortality (HR: 0.61).
• Following a meticulous 1:1 propensity score matching analysis between the two cohorts, the matched population revealed a notable decrease in 28-day mortality within the RBC transfusion group (HR: 0.60).
• The researchers observed that a SOFA score ≥ 5, a Base Excess value < 3, and an eGFR < 30 may be considered when evaluating the potential need for RBC transfusion.

The findings revealed that RBC transfusion may enhance the 28-day survival rate in septic patients with concurrent CKD. In particular subgroups, factors like base excess value, SOFA score, and estimated glomerular filtration rate significantly influence treatment outcomes. Consequently, these variables should be considered when determining the need for initial RBC transfusion. The researchers suggest the necessity for additional research to validate these findings through randomized clinical trials.

"Our study found a significant link between RBC transfusion and reduced 28-day mortality in septic patients with CKD. However, its generalizability is limited due to reliance on data from a single U.S. academic center, which may not reflect broader practices or patient demographics, along with inherent retrospective limitations," the researchers concluded.

Reference:

Chen, L., Lu, H., Lv, C., Ni, H., Yu, R., Zhang, B., & Hu, X. (2024). Association between red blood cells transfusion and 28-day mortality rate in septic patients with concomitant chronic kidney disease. Scientific Reports, 14(1), 1-10. https://doi.org/10.1038/s41598-024-75643-3