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A number of studies have observed decreased survival associated with transfusion. Leukocyte-mediated immunosuppression may contribute to postoperative infectious complications. There is evidence for a benefit with the use of leukocyte reduced transfusion, but it is unclear among septic shock patients. In Japan, leukocyte-depleted blood products have been used since 2007. We assessed the effect of transfusion and the efficacy of the use of leukocyte-depleted blood products for new onset of septic shock and mortality among patients with septic shock.
A total of 101 septic shock patients at a single university general ICU were enrolled in the study. A target hemoglobin (Hb) concentration of 10 g/dl (Ht 30%) was considered for allogeneic red cell transfusion (to maintain central venous saturation >70%) during the early phase of severe sepsis, and Hb was kept in the range of 7 to 9 g/dl in the stable phase except for the patients with particular disease (acute coronary syndrome, and so forth). Fresh frozen plasma was used to keep PT-INR <1.67, and platelet transfusion was done due to the patient's condition (for example, postoperative, and so forth).
Eighty-six patients (85%) received transfusion (group T: age 68 ± 12, APACHE II 25.9 ± 9.5) and 15 received no blood product (group NT: age 63 ± 14, APACHE II 27.4 ± 3.2). Frequent sites of infection were the lung (46%), peritoneum (17%), mediastinum (12%), and gastrointestinal tract (7%) (NS between groups). Overall mortality for group T vs group NT was 27/86 (31%) vs 3/15 (20%) (P = 0.54). Onset of new septic shock for group T vs group NT was 27/86 (31%) vs 4/15 (27%) (P = 0.71). Survivors received 26.6 ± 31.2 Japanese units of total blood product and 44.6 ± 35.6 units for patients who died, respectively (1 American unit is almost equivalent to 2 Japanese units) (P = 0.013). For group T, 56 patients received leukocyte-reduced blood product (LRB) and 29 received ordinary product (Cont.). Overall mortality for LRB vs Cont. was 40/56 (71%) vs 18/29 (62%) (P = 0.38).
The total amount of blood products received was highly associated with increased mortality, but there was no obvious adverse effect of transfusion to the onset of new septic shock. No association between overall mortality and the use of leukocyte depleted blood was identified in patients with septic shock.