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Using arterial-venous oxygen difference to guide red blood cell transfusion strategy.


ABSTRACT:

Background

Guidelines recommend a restrictive red blood cell transfusion strategy based on hemoglobin (Hb) concentrations in critically ill patients. We hypothesized that the arterial-venous oxygen difference (A-V O2diff), a surrogate for the oxygen delivery to consumption ratio, could provide a more personalized approach to identify patients who may benefit from transfusion.

Methods

A prospective observational study including 177 non-bleeding adult patients with a Hb concentration of 7.0-10.0?g/dL within 72?h after ICU admission. The A-V O2diff, central venous oxygen saturation (ScvO2), and oxygen extraction ratio (O2ER) were noted when a patient's Hb was first within this range. Transfusion decisions were made by the treating physician according to institutional policy. We used the median A-V O2diff value in the study cohort (3.7?mL) to classify the transfusion strategy in each patient as "appropriate" (patient transfused when the A-V O2diff?>?3.7?mL or not transfused when the A-V O2diff???3.7?mL) or "inappropriate" (patient transfused when the A-V O2diff???3.7?mL or not transfused when the A-V O2diff?>?3.7?mL). The primary outcome was 90-day mortality.

Results

Patients managed with an "appropriate" strategy had lower mortality rates (23/96 [24%] vs. 36/81 [44%]; p?=?0.004), and an "appropriate" strategy was independently associated with reduced mortality (hazard ratio [HR] 0.51 [95% CI 0.30-0.89], p?=?0.01). There was a trend to less acute kidney injury with the "appropriate" than with the "inappropriate" strategy (13% vs. 26%, p?=?0.06), and the Sequential Organ Failure Assessment (SOFA) score decreased more rapidly (p?=?0.01). The A-V O2diff, but not the ScvO2, predicted 90-day mortality in transfused (AUROC?=?0.656) and non-transfused (AUROC?=?0.630) patients with moderate accuracy. Using the ROC curve analysis, the best A-V O2diff cutoffs for predicting mortality were 3.6?mL in transfused and 3.5?mL in non-transfused patients.

Conclusions

In anemic, non-bleeding critically ill patients, transfusion may be associated with lower 90-day mortality and morbidity in patients with higher A-V O2diff.

Trial registration

ClinicalTrials.gov, NCT03767127. Retrospectively registered on 6 December 2018.

SUBMITTER: Fogagnolo A 

PROVIDER: S-EPMC7171832 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Using arterial-venous oxygen difference to guide red blood cell transfusion strategy.

Fogagnolo Alberto A   Taccone Fabio Silvio FS   Vincent Jean Louis JL   Benetto Giulia G   Cavalcante Elaine E   Marangoni Elisabetta E   Ragazzi Riccardo R   Creteur Jacques J   Volta Carlo Alberto CA   Spadaro Savino S  

Critical care (London, England) 20200420 1


<h4>Background</h4>Guidelines recommend a restrictive red blood cell transfusion strategy based on hemoglobin (Hb) concentrations in critically ill patients. We hypothesized that the arterial-venous oxygen difference (A-V O<sub>2diff</sub>), a surrogate for the oxygen delivery to consumption ratio, could provide a more personalized approach to identify patients who may benefit from transfusion.<h4>Methods</h4>A prospective observational study including 177 non-bleeding adult patients with a Hb c  ...[more]

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