Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients

Martin D. Zielinski, Gregory A. Wilson, Pamela M. Johnson, Stephanie F. Polites, Donald H. Jenkins, W. Scott Harmsen, John B. Holcomb, Charles E. Wade, Deborah J. Del Junco, Erin E. Fox, James R. Stubbs

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Overtransfusion of packed red blood cells is known to increase the risk of death in stable patients. With the delineation of minimum transfusion ratios in hemorrhaging patients complete, attention must be turned to the other end of the massive transfusion spectrum-that of defining the maximum transfusion of packed red blood cells. We aimed to define the ideal hemoglobin range 24 hours after anatomic hemostasis associated with the lowest mortality. Methods: Massive-transfusion patients (≥10 units packed red blood cells within 24 hours) were reviewed from 2010-2013. The hemoglobin 24 ± 6 hours after anatomic hemostasis was used to stratify patients into undertransfusion (<8.0 g/dL), hemoglobin transfusion target (8.0-11.9 g/dL), and overtransfusion (>12.0 g/dL) groups; patients not surviving to 24 hours were excluded. Results: We identified 418 patients (351 [84%] in the hemoglobin transfusion target group, 38 [9%] in the undertransfusion group, and 29 [7%] in the overtransfusion group) with an overall mortality of 18%. Undertransfusion patients had the greatest risk of death (odds ratio 3.3; 95% confidence interval 1.6-6.7) followed by overtransfusion patients (odds ratio 2.5; 95% confidence interval 1.1-5.6). Though pretransfusion hemoglobin was similar (9.5 ± 2.2 g/dL vs 9.5 ± 2.3 g/dL), overtransfusion patients had greater hemoglobin values during massive transfusion (8.3 ± 3.0 g/dL vs 6.9 ± 1.4 g/dL), persisting until hospital dismissal/death (11.4 ± 2.3 g/dL vs 9.6 ± 1.1 g/dL). In total, 657.4 excess packed red blood cell units were transfused (1.9 ± 1.5 per patient). Conclusion: Overtransfusion patients had increased mortality, comparable to undertransfusion patients, despite younger age and fewer comorbidities. Shorter massive transfusion durations foster a scenario in which patients are at greater risk of overtransfusion.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StateAccepted/In press - 2016

Fingerprint

Resuscitation
Hemoglobins
Erythrocytes
Hemostasis
Mortality
Odds Ratio
Confidence Intervals
Erythrocyte Transfusion
Comorbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Zielinski, M. D., Wilson, G. A., Johnson, P. M., Polites, S. F., Jenkins, D. H., Harmsen, W. S., ... Stubbs, J. R. (Accepted/In press). Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients. Surgery (United States). https://doi.org/10.1016/j.surg.2016.05.022

Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients. / Zielinski, Martin D.; Wilson, Gregory A.; Johnson, Pamela M.; Polites, Stephanie F.; Jenkins, Donald H.; Harmsen, W. Scott; Holcomb, John B.; Wade, Charles E.; Del Junco, Deborah J.; Fox, Erin E.; Stubbs, James R.

In: Surgery (United States), 2016.

Research output: Contribution to journalArticle

Zielinski, MD, Wilson, GA, Johnson, PM, Polites, SF, Jenkins, DH, Harmsen, WS, Holcomb, JB, Wade, CE, Del Junco, DJ, Fox, EE & Stubbs, JR 2016, 'Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients', Surgery (United States). https://doi.org/10.1016/j.surg.2016.05.022
Zielinski, Martin D. ; Wilson, Gregory A. ; Johnson, Pamela M. ; Polites, Stephanie F. ; Jenkins, Donald H. ; Harmsen, W. Scott ; Holcomb, John B. ; Wade, Charles E. ; Del Junco, Deborah J. ; Fox, Erin E. ; Stubbs, James R. / Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients. In: Surgery (United States). 2016.
@article{fb7499d83c7346a2aa6b1ece3024a8cf,
title = "Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients",
abstract = "Background: Overtransfusion of packed red blood cells is known to increase the risk of death in stable patients. With the delineation of minimum transfusion ratios in hemorrhaging patients complete, attention must be turned to the other end of the massive transfusion spectrum-that of defining the maximum transfusion of packed red blood cells. We aimed to define the ideal hemoglobin range 24 hours after anatomic hemostasis associated with the lowest mortality. Methods: Massive-transfusion patients (≥10 units packed red blood cells within 24 hours) were reviewed from 2010-2013. The hemoglobin 24 ± 6 hours after anatomic hemostasis was used to stratify patients into undertransfusion (<8.0 g/dL), hemoglobin transfusion target (8.0-11.9 g/dL), and overtransfusion (>12.0 g/dL) groups; patients not surviving to 24 hours were excluded. Results: We identified 418 patients (351 [84{\%}] in the hemoglobin transfusion target group, 38 [9{\%}] in the undertransfusion group, and 29 [7{\%}] in the overtransfusion group) with an overall mortality of 18{\%}. Undertransfusion patients had the greatest risk of death (odds ratio 3.3; 95{\%} confidence interval 1.6-6.7) followed by overtransfusion patients (odds ratio 2.5; 95{\%} confidence interval 1.1-5.6). Though pretransfusion hemoglobin was similar (9.5 ± 2.2 g/dL vs 9.5 ± 2.3 g/dL), overtransfusion patients had greater hemoglobin values during massive transfusion (8.3 ± 3.0 g/dL vs 6.9 ± 1.4 g/dL), persisting until hospital dismissal/death (11.4 ± 2.3 g/dL vs 9.6 ± 1.1 g/dL). In total, 657.4 excess packed red blood cell units were transfused (1.9 ± 1.5 per patient). Conclusion: Overtransfusion patients had increased mortality, comparable to undertransfusion patients, despite younger age and fewer comorbidities. Shorter massive transfusion durations foster a scenario in which patients are at greater risk of overtransfusion.",
author = "Zielinski, {Martin D.} and Wilson, {Gregory A.} and Johnson, {Pamela M.} and Polites, {Stephanie F.} and Jenkins, {Donald H.} and Harmsen, {W. Scott} and Holcomb, {John B.} and Wade, {Charles E.} and {Del Junco}, {Deborah J.} and Fox, {Erin E.} and Stubbs, {James R.}",
year = "2016",
doi = "10.1016/j.surg.2016.05.022",
language = "English (US)",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Ideal hemoglobin transfusion target for resuscitation of massive-transfusion patients

AU - Zielinski, Martin D.

AU - Wilson, Gregory A.

AU - Johnson, Pamela M.

AU - Polites, Stephanie F.

AU - Jenkins, Donald H.

AU - Harmsen, W. Scott

AU - Holcomb, John B.

AU - Wade, Charles E.

AU - Del Junco, Deborah J.

AU - Fox, Erin E.

AU - Stubbs, James R.

PY - 2016

Y1 - 2016

N2 - Background: Overtransfusion of packed red blood cells is known to increase the risk of death in stable patients. With the delineation of minimum transfusion ratios in hemorrhaging patients complete, attention must be turned to the other end of the massive transfusion spectrum-that of defining the maximum transfusion of packed red blood cells. We aimed to define the ideal hemoglobin range 24 hours after anatomic hemostasis associated with the lowest mortality. Methods: Massive-transfusion patients (≥10 units packed red blood cells within 24 hours) were reviewed from 2010-2013. The hemoglobin 24 ± 6 hours after anatomic hemostasis was used to stratify patients into undertransfusion (<8.0 g/dL), hemoglobin transfusion target (8.0-11.9 g/dL), and overtransfusion (>12.0 g/dL) groups; patients not surviving to 24 hours were excluded. Results: We identified 418 patients (351 [84%] in the hemoglobin transfusion target group, 38 [9%] in the undertransfusion group, and 29 [7%] in the overtransfusion group) with an overall mortality of 18%. Undertransfusion patients had the greatest risk of death (odds ratio 3.3; 95% confidence interval 1.6-6.7) followed by overtransfusion patients (odds ratio 2.5; 95% confidence interval 1.1-5.6). Though pretransfusion hemoglobin was similar (9.5 ± 2.2 g/dL vs 9.5 ± 2.3 g/dL), overtransfusion patients had greater hemoglobin values during massive transfusion (8.3 ± 3.0 g/dL vs 6.9 ± 1.4 g/dL), persisting until hospital dismissal/death (11.4 ± 2.3 g/dL vs 9.6 ± 1.1 g/dL). In total, 657.4 excess packed red blood cell units were transfused (1.9 ± 1.5 per patient). Conclusion: Overtransfusion patients had increased mortality, comparable to undertransfusion patients, despite younger age and fewer comorbidities. Shorter massive transfusion durations foster a scenario in which patients are at greater risk of overtransfusion.

AB - Background: Overtransfusion of packed red blood cells is known to increase the risk of death in stable patients. With the delineation of minimum transfusion ratios in hemorrhaging patients complete, attention must be turned to the other end of the massive transfusion spectrum-that of defining the maximum transfusion of packed red blood cells. We aimed to define the ideal hemoglobin range 24 hours after anatomic hemostasis associated with the lowest mortality. Methods: Massive-transfusion patients (≥10 units packed red blood cells within 24 hours) were reviewed from 2010-2013. The hemoglobin 24 ± 6 hours after anatomic hemostasis was used to stratify patients into undertransfusion (<8.0 g/dL), hemoglobin transfusion target (8.0-11.9 g/dL), and overtransfusion (>12.0 g/dL) groups; patients not surviving to 24 hours were excluded. Results: We identified 418 patients (351 [84%] in the hemoglobin transfusion target group, 38 [9%] in the undertransfusion group, and 29 [7%] in the overtransfusion group) with an overall mortality of 18%. Undertransfusion patients had the greatest risk of death (odds ratio 3.3; 95% confidence interval 1.6-6.7) followed by overtransfusion patients (odds ratio 2.5; 95% confidence interval 1.1-5.6). Though pretransfusion hemoglobin was similar (9.5 ± 2.2 g/dL vs 9.5 ± 2.3 g/dL), overtransfusion patients had greater hemoglobin values during massive transfusion (8.3 ± 3.0 g/dL vs 6.9 ± 1.4 g/dL), persisting until hospital dismissal/death (11.4 ± 2.3 g/dL vs 9.6 ± 1.1 g/dL). In total, 657.4 excess packed red blood cell units were transfused (1.9 ± 1.5 per patient). Conclusion: Overtransfusion patients had increased mortality, comparable to undertransfusion patients, despite younger age and fewer comorbidities. Shorter massive transfusion durations foster a scenario in which patients are at greater risk of overtransfusion.

UR - http://www.scopus.com/inward/record.url?scp=84979590879&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979590879&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2016.05.022

DO - 10.1016/j.surg.2016.05.022

M3 - Article

C2 - 27450716

AN - SCOPUS:84979590879

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

ER -