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Use of blood transfusions may be halved for patients with blood poisoning

K1's Anne Berit Guttormsen and Brit Sjøbø from Haukeland University Hospital, published together with Nordic colleagues an article in the leading medical journal The New England Journal of Medicine which shows that blood transfusions can be halved in patients with sepsis.

Photo of Anne Berit Guttormsen and Brit Sjøbø
Anne Berit Guttormsen og Brit Sjøbø
Photo:
Kari Nytun

"Hot topic"

The TRISS trial or Transfusion Requirements In Septic Shock was also presented at the Hot Topics Session at the European Intensive Care convention in Barcelona the same day.

Halve the consumption of blood

The trial included 1005 patients with septic shock from 32 intensive care units in Scandinavia. Blood transfusion is frequently given to patients in intensive care units, as a low blood count is considered dangerous for these critically ill patients. The results of the trial on the other hand, show that you can halve the use of blood and reduce the share of patients with septic shock who receive blood transfusions by a third.

The trial is the largest of its kind, and the results will form the basis of improved treatment for patients with blood poisoning. Every year thousands of Norwegians suffer blood poisoning and at global level there are millions, so these results could be extremely significant for total blood consumption.

This also has positive socio-economic consequences, since the cost of transfusions is high.

Level 2-publication

The TRISS trial was published in the New England Journal of Medicine (NEJM) 1 October 2014. The study was conducted by SCCTG, Scandinavian Critical Care Trials Group, and is the network's second major study. The so-called 6S study investigating fluid therapy, use of Ringer acetate or HES in the primary fluid resuscitation of patients with severe sepsis were published in 2011, also in the NEJM.

Abstract

Background
Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established.

Methods
In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay. The primary outcome measure was death by 90 days after randomization.

Results
We analyzed data from 998 of 1005 patients (99.3%) who underwent randomization. The two intervention groups had similar baseline characteristics. In the ICU, the lower-threshold group received a median of 1 unit of blood (interquartile range, 0 to 3) and the higher-threshold group received a median of 4 units (interquartile range, 2 to 7). At 90 days after randomization, 216 of 502 patients (43.0%) assigned to the lower-threshold group, as compared with 223 of 496 (45.0%) assigned to the higher-threshold group, had died (relative risk, 0.94; 95% confidence interval, 0.78 to 1.09; P = 0.44). The results were similar in analyses adjusted for risk factors at baseline and in analyses of the per-protocol populations. The numbers of patients who had ischemic events, who had severe adverse reactions, and who required life support were similar in the two intervention groups.

Conclusions
Among patients with septic shock, mortality at 90 days and rates of ischemic events and use of life support were similar among those assigned to blood transfusion at a higher hemoglobin threshold and those assigned to blood transfusion at a lower threshold; the latter group received fewer transfusions.

See the publication here.