Long-term survival in the intensive care unit after erythrocyte blood transfusion.

Background: Erythrocyte blood transfusions are commonly used in intensive care units, yet little is known about their effects on long-term survival.

Objective: To determine the effect of erythrocyte blood transfusion in intensive care units on long-term survival.

Methods: Retrospective analysis of a prospectively collected database of 2213 patients admitted January 27, 2001, to April 30, 2002, to the cardiac, burn, neurological-neurosurgical, and combined medical-surgical intensive care units in a tertiary care, university-affiliated, urban medical center. Further analysis was done on a case-control subgroup (n=556) formed by matching scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and propensity scores.

Results: Although transfusion was univariably associated with increased risk of death at all 3 times (0-30, 31-180, and >180 days after admission to the unit), multivariable adjustment with Cox modeling showed that transfusion had no association with mortality for the first 2 intervals (0-30 and 31-180 days), but was associated with a 25% lower risk of death (hazard ratio, 0.75; 95% confidence interval, 0.57-0.99; P=.04) in patients who survived at least 180 days after admission to the unit. In the case-control patients, after correction for APACHE II risk of death and propensity to receive a transfusion, transfusion had no association with mortality for the first 2 intervals, but was associated with 29% lowered risk of death (hazard ratio, 0.71; 95% confidence interval, 0.50-0.99; P=.046).

Conclusion: Blood transfusion was associated with a decreased risk of late (>180 days) death in intensive care patients.