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Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock

2014; Massachusetts Medical Society; Volume: 371; Issue: 15 Linguagem: Inglês

10.1056/nejmoa1406617

1533-4406

Lars Broksø Holst, Nicolai Haase, Jørn Wetterslev, Jan Wernerman, Anne Berit Guttormsen, Sari Karlsson, Pär I. Johansson, Anders Åneman, Marianne Vang, Robert Winding, Lars Nebrich, Helle Lykkeskov Nibro, Bodil Steen Rasmussen, Johnny R M Lauridsen, Jane Stab Nielsen, Anders Oldner, Ville Pettilä, Maria Cronhjort, Lasse Andersen, U. G. Pedersen, Nanna Reiter, Jørgen Wiis, Jonathan O. White, Lene Russell, Klaus Thornberg, Peter Buhl Hjortrup, R Müller, Morten Hylander Møller, Morten Steensen, Inga Tjäder, Kristina Kilsand, Suzanne Odeberg-Wernerman, Brit Sjøbø, Henning Bundgaard, Maria A Thyø, David Lodahl, Rikke Mærkedahl, Carsten Albeck, Dorte Illum, Mary Kruse, Per Winkel, Anders Perner,

Trauma, Hemostasis, Coagulopathy, Resuscitation

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.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.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.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. (Funded by the Danish Strategic Research Council and others; TRISS ClinicalTrials.gov number, NCT01485315.).