Journal of Critical Care
Volume 26, Issue 4 , Pages 431.e1-431.e9, August 2011

Patient factors associated with transfusion practices in Veterans Affairs intensive care units: Implications for further research☆☆☆★

  • Yew Y. Ding, MBBS, FRCP, MPH

      Affiliations

    • Corresponding Author InformationCorresponding authors. Yew Y. Ding is to be contacted for communications on the paper at Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433. Dan R. Berlowitz is to be contacted for reprints at VA Bedford Hospital, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital (152), Bedford, MA 01730, and Boston University School of Public Health, Boston, MA 02118.
    • ,
  • Boris Kader, PhD
    • ,
  • Cindy L. Christiansen, PhD
    • ,
  • Dan R. Berlowitz, MD, MPH

      Affiliations

    • Corresponding Author InformationCorresponding authors. Yew Y. Ding is to be contacted for communications on the paper at Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433. Dan R. Berlowitz is to be contacted for reprints at VA Bedford Hospital, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital (152), Bedford, MA 01730, and Boston University School of Public Health, Boston, MA 02118.

published online 04 March 2011.

Abstract 

Purpose

We sought to describe how patient characteristics influence the frequency of red blood cell (RBC) transfusions among critically ill patients after taking into account hemoglobin (Hgb) level.

Methods

This was a retrospective cohort study using secondary analysis of administrative data of Veterans Affairs intensive care unit (ICU) admissions. The outcome of interest was RBC transfusion during the first 30 days of ICU admission. Besides Hgb level, explanatory variables included demographics, admission-related information, comorbid conditions, ICU admission diagnosis, and selected laboratory test results. Logistic regression modeling quantified associations between explanatory variables and transfusion.

Results

For 259 281 ICU admissions from 2001 to 2005, the overall incidence of RBC transfusion was 12.5%. Increased age, male gender, admission for acute myocardial infarction (AMI), and comorbid heart disease were independently associated with transfusion. Compared with admission for reference diagnoses, transfusions were more likely for admissions for AMI, unstable angina, and congestive heart failure only at Hgb levels below 11, 9, and 6 g/dL, respectively.

Conclusions

Intensive care unit patients admitted for AMI, unstable angina, and congestive heartfailure had higher likelihood of receiving RBC transfusions below specific Hgb levels varying from 6 to 11 g/dL. Further research is needed to determine how these transfusion practices influence outcomes.

Keywords: Blood transfusion, Intensive care units, Anemia, Risk adjustment, Comorbidity, Hospital mortality

 

☆ Sponsors: the National Medical Research Council (NMRC) of Singapore, Ortho Biotech Clinical Affairs, and the Department of Veterans Affairs played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

☆☆ Competing interests: the authors declare that they have no competing interests.

★ Authors' contributions: Y.Y.D. contributed to the study design, data analyses and interpretation, and drafted the manuscript. B.K. acquired and analyzed the data, contributed to its interpretation, and revised the manuscript. C.C. contributed to the study design, data analysis and interpretation, and revised the manuscript. D.B. conceived the study, contributed to study design and data interpretation, and revised the manuscript. All authors read and approved the final manuscript.

PII: S0883-9441(10)00351-5

doi:10.1016/j.jcrc.2010.12.012

Journal of Critical Care
Volume 26, Issue 4 , Pages 431.e1-431.e9, August 2011

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