Shock Severity Modifies Associations Between RBC Transfusion in the First 48 Hours of Sepsis Onset and the Duration of Organ Dysfunction in Critically Ill Septic Children*

Abstract

Objective: To test the hypothesis that early RBC transfusion is associated with duration of organ dysfunction in critically ill septic children. Design: Secondary analysis of a single-center prospective observational study. Multivariable negative binomial regression was used to determine relationships between RBC transfusion within 48 hours of sepsis onset and number of days in 14 with organ dysfunction, or with multiple organ dysfunction syndrome. Setting: A PICU at a quaternary care children’s hospital. Patients: Children less than 18 years old with severe sepsis/septic shock by consensus criteria were included. Patients with RBC transfusion prior to sepsis onset and those on extracorporeal membrane oxygenation support within 48 hours of sepsis onset were excluded. Interventions: None. Measurements and Main Results: Ninety-four patients were included. Median age was 6 years (0–13 yr); 61% were male. Seventy-eight percentage had septic shock, and 41 (44%) were transfused RBC within 48 hours of sepsis onset (early RBC transfusion). On multivariable analyses, early RBC transfusion was independently associated with 44% greater organ dysfunction days (adjusted relative risk, 1.44 [1.04–2.]; p = 0.03), although risk differed by severity of illness (interaction p = 0.004) and by shock severity (interaction p = 0.04 for Vasoactive Inotrope Score and 0.03 for shock index). Relative risks for multiple organ dysfunction syndrome days varied by shock severity (interaction p = 0.008 for Vasoactive Inotrope Score and 0.01 for shock index). Risks associated with early RBC transfusion were highest for the children with the lowest shock severities. Conclusions: In agreement with previous studies, early RBC transfusion was independently associated with longer duration of organ dysfunction. Ours is among the first studies to document different transfusion-associated risks based on clinically available measures of shock severity, demonstrating greater transfusion-associated risks in children with less severe shock. Larger multicenter studies to verify these interaction effects are essential to plan much-needed RBC transfusion trials for critically ill septic children.

Hydrocortisone treatment is associated with a longer duration of MODS in pediatric patients with severe sepsis and immunoparalysis

“…Additionally, our results showed that receipt of a RBC transfusion was also associated with a higher risk of a longer duration of MODS, an observation that was recently the subject of another secondary analysis of this data set [32]. We also found that the presence of baseline immune compromise was associated with fewer MODS days in patients with immunoparalysis.…”

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

“…* * e C4 levels of the control group before and after intervention were obviously different (t � 10.183, P < 0.001). and amount of diet need to be controlled [17][18][19][20]. Food is provided according to the children's preferences to improve their interest in eating and increase their intake of energy and protein.…”

Outcomes Associated With Early RBC Transfusion in Pediatric Severe Sepsis: A Propensity-Adjusted Multicenter Cohort Study

“…If such a heterogeneity of treatment effect exists, the overall net effect may show no difference between groups, but this net noneffect may not be informative for individual patients. In support of this hypothesis, our previous single center data in children with severe sepsis/septic shock suggest that hemodynamic measures, suggesting impaired ability to compensate (or sustain compensation) for anemia would likely identify children who benefit from RBC transfusion better than hemoglobin concentration alone (5). Understanding and evaluating patient-specific indications for RBC transfusion based on hemodynamic parameters and markers of the adequacy of oxygen delivery remains imperative to design more informative clinical trials of RBC transfusion strategies for children with shock.…”

“…The extent to which RBC transfusion contributes to organ dysfunction in critically ill children remains unclear. In our previous single-center study, early RBC transfusion was associated with longer durations of both single and multiple organ dysfunction in children with severe sepsis/septic shock, though these associations were modified by measures related to hemodynamics (vasoactive inotrope score and shock index) such that adverse effects related to RBC transfusion were greatest in those with the lowest shock severities (5). In a previous single-center observational study of critically ill children across multiple diagnoses, RBC transfusion was independently associated with the development of new or progressive MODS (aOR 3.85, 95% CI 2.4-6.2), accounting for PRISM III score, age, and the presence of congenital heart disease (8).…”