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

Abstract

BackgroundRandomized controlled trial evidence supports a restrictive strategy of red blood cell (RBC) transfusion, but significant variation in clinical transfusion practice persists. Patient characteristics other than hemoglobin levels may influence the decision to transfuse RBCs and explain some of this variation. Our objective was to evaluate the role of patient comorbidities and severity of illness in predicting inpatient red blood cell transfusion events.MethodsWe developed a predictive model of inpatient RBC transfusion using comprehensive electronic medical record (EMR) data from 21 hospitals over a four year period (2008-2011). Using a retrospective cohort study design, we modeled predictors of transfusion events within 24 hours of hospital admission and throughout the entire hospitalization. Model predictors included administrative data (age, sex, comorbid conditions, admission type, and admission diagnosis), admission hemoglobin, severity of illness, prior inpatient RBC transfusion, admission ward, and hospital.ResultsThe study cohort included 275,874 patients who experienced 444,969 hospitalizations. The 24 hour and overall inpatient RBC transfusion rates were 7.2% and 13.9%, respectively. A predictive model for transfusion within 24 hours of hospital admission had a C-statistic of 0.928 and pseudo-R2 of 0.542; corresponding values for the model examining transfusion through the entire hospitalization were 0.872 and 0.437. Inclusion of the admission hemoglobin resulted in the greatest improvement in model performance relative to patient comorbidities and severity of illness.ConclusionsData from electronic medical records at the time of admission predicts with very high likelihood the incidence of red blood transfusion events in the first 24 hours and throughout hospitalization. Patient comorbidities and severity of illness on admission play a small role in predicting the likelihood of RBC transfusion relative to the admission hemoglobin.

Nomogram to predict perioperative blood transfusion for hepatopancreaticobiliary and colorectal surgery

“…Specifically, increasing patient age, race, pre‐existing co‐morbidity, preoperative INR and the type of procedure were all predictive of an increased odds of transfusion. Consistent with the present results, Roubinian and colleagues demonstrated that preoperative variables including age, sex, co‐morbidities, admission type and diagnosis, coupled with serum haemoglobin levels at admission, were sufficient to develop a model with very high performance in a large cohort of both medical and surgical patients. Perhaps as expected, the majority of studies evaluating the risk of transfusion have demonstrated preoperative serum haemoglobin levels to be strongly predictive of blood transfusion.…”

“…Consistent with the present results, Roubinian and colleagues demonstrated that preoperative variables including age, sex, co‐morbidities, admission type and diagnosis, coupled with serum haemoglobin levels at admission, were sufficient to develop a model with very high performance in a large cohort of both medical and surgical patients. Perhaps as expected, the majority of studies evaluating the risk of transfusion have demonstrated preoperative serum haemoglobin levels to be strongly predictive of blood transfusion. Furthermore, significant differences in the haemoglobin thresholds for transfusion used by providers have been reported.…”

Decreased Red Blood Cell Use and Mortality in Hospitalized Patients

“…4 We also adjusted for patients’ pread-mission hemoglobin level and lowest hospital hemoglobin level. 5 We then compared standardized mortality ratios for transfused vs nontransfused patients using Poisson regression. Trends in RBC use and unadjusted 30-day mortality were assessed using linear regression.…”

Evaluating the appropriateness of blood component utilization in burns patients

“…5 However, decision is made taking other factors into consideration: type of surgery, extent of blood loss, presence of adverse clinical conditions like age of patient and presence of cardiopulmonary compromise). [16][17][18][19][20] Among patients in intensive care, restrictive transfusion threshold with Hb values between 7-8 gm/dL does not increase mortality, morbidity or duration of hospitalization. Exceptions to restrictive threshold include patients with cardiovascular disease.…”