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American Journal of Critical Care. 2009;18: 124-131 doi:10.4037/ajcc2009193
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Long-term Survival in the Intensive Care Unit After Erythrocyte Blood Transfusion

By Milo Engoren, MD and Cynthia Arslanian-Engoren, RN, PhD, ACNS-BC. Milo Engoren is an anesthesiologist and intensivist in the Departments of Anesthesiology and Internal Medicine at St Vincent Mercy Medical Center and a clinical associate professor in the Department of Anesthesiology at the University of Toledo Health Sciences College in Toledo, Ohio. Cynthia Arslanian-Engoren is an associate professor in the School of Nursing at the University of Michigan in Ann Arbor.

Corresponding author: Milo Engoren, MD, 2213 Cherry St, Toledo, OH 43608 (e-mail: engoren{at}pol.net).

Background Erythrocyte blood transfusions are commonly used in intensive care units, yet little is known about their effects on long-term survival.

Objective To determine the effect of erythrocyte blood transfusion in intensive care units on long-term survival.

Methods Retrospective analysis of a prospectively collected database of 2213 patients admitted January 27, 2001, to April 30, 2002, to the cardiac, burn, neurological-neurosurgical, and combined medical-surgical intensive care units in a tertiary care, university-affiliated, urban medical center. Further analysis was done on a case-control subgroup (n = 556) formed by matching scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and propensity scores.

Results Although transfusion was univariably associated with increased risk of death at all 3 times (0–30, 31–180, and >180 days after admission to the unit), multivariable adjustment with Cox modeling showed that transfusion had no association with mortality for the first 2 intervals (0–30 and 31–180 days), but was associated with a 25% lower risk of death (hazard ratio, 0.75; 95% confidence interval, 0.57–0.99; P = .04) in patients who survived at least 180 days after admission to the unit. In the case-control patients, after correction for APACHE II risk of death and propensity to receive a transfusion, transfusion had no association with mortality for the first 2 intervals, but was associated with 29% lowered risk of death (hazard ratio, 0.71; 95% confidence interval, 0.50–0.99; P=.046).

Conclusion Blood transfusion was associated with a decreased risk of late (>180 days) death in intensive care patients.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the effect of erythrocyte blood transfusion in the intensive care unit on long-term survivability.
  2. Discuss the differences between the Cox proportional hazard modeling and the Kaplan-Meier survival curve.
  3. Integrate findings of the research study into nursing practice in the intensive care unit.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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Copyright © 2009 by the American Association of Critical-Care Nurses.