Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity

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Written by: Nareg H Roubinian, Edward L Murphy, Bix E Swain, Marla N Gardner, Vincent Liu,Gabriel J Escobar [1]


Introduction

Randomized controlled trial (RCT) shows support for restrictive strategy of red blood cell (RBC) transfusion where these trials show that there is similar or better patient outcomes than in a more liberal strategy. This study looks at patient characteristics other than hemoglobin that might lead to this continued variation in clinical practices for transfusion.

Methods

This study included data from electronic medical records (EMR) from 21 hospitals over a four year period. This study used a retrospective cohort study design to model predictors for administrative data, admission hemoglobin, severity of illness, prior inpatient RBC transfusion, admission ward, and hospital.

Results

The data shows that there are higher illness severity, comorbidity burden, hospital length of stay, inpatient mortality, and 30 day mortality in the transfused cohort versus non-transfused cohort. The data also shows increased clinical detail was better in predicting RBC transfusions at 24 hours and through hospitalizations.

Discussion

The predictor models, mentioned in the methods section, were significant in predicting RBC transfusions, however, admission hemoglobin was far more likely to predict RBC transfusions.

Conclusion

The authors discuss the importance of the hemoglobin level but also that there are other predictors at the time of hospitalizations that can also be predictors for RBC transfusions.

Comment

This is an interesting study that looks at the possible predictors for RBC transfusions and the continued variance with clinicians when they choose to modify the more restrictive strategy for RBC transfusions.

Reference

  1. Roubinian N.H., Murphy E.L., Swain B.E., Gardner M.N., Liu V., Escobar G.J.. (2014). Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity. BMC Health Services Research, 14:213. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101854/