Erythropoietin in ICU patients receiving early red blood cell transfusions: A retrospective study of the impact on transfusion requirements

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-03-19 DOI:10.1016/j.jcrc.2025.155052

Thomas Carpentier , Anthony Merlin , Arnaud Cappe , Matthieu Metzelard , Léonie Villeret , Patrick Jeanjean , Yazine Mahjoub , Julien Maizel , Hervé Dupont , Stéphanie Malaquin , Aurélien Mary

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Abstract

Purpose

Anemia correlates with increased ICU mortality; but the use of erythropoietin (EPO) as a treatment remains debated. We sought to assess EPO use in ICU severe anemia.

Methods

A retrospective single-center study was conducted in four adult ICUs. Inclusion criteria were ICU stay ≥10 days (to limit immortality bias) and RBC transfusion within the first 48 h (an indication of severe anemia likely to justify EPO). EPO contraindication was an exclusion criterion. Univariate tests were followed by a multivariable analysis.

Results

Over a 28-month period, 190 patients (69 with EPO) were included. EPO subgroups displayed had a higher prevalence of hemorrhagic shock and surgical ICU admissions. EPO administration was significantly associated with a lower requirement for late RBC transfusions in trauma and non-trauma subgroups, with odds ratios [95 % confidence interval] of 0.29 [0.10–0.85] and 0.03 [0.004–0.18], respectively. In the EPO subgroup, the median hemoglobin level rose by 1.2 g/dL. Cox model showed a significant association with mortality at day 28 and 365.

Conclusion

Our study supports the hypothesis whereby EPO administration in severely anemic ICU patients reduces late transfusion needs, with a potentially higher survival rate. Systematic EPO use post-RBC transfusion in ICU patients warrants further investigation.

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接受早期红细胞输注的ICU患者的促红细胞生成素：对输血需求影响的回顾性研究

目的：贫血与ICU死亡率增高相关；但使用促红细胞生成素（EPO）作为一种治疗方法仍存在争议。我们试图评估促生成素在ICU重症贫血中的应用。方法对4例成人icu进行回顾性单中心研究。纳入标准为ICU住院≥10天（以限制不朽偏见），并在前48小时内输血RBC（可能证明EPO合理的严重贫血的指征）。EPO禁忌症是排除标准。单变量检验后进行多变量分析。结果在28个月的时间内，纳入190例患者（69例EPO）。EPO亚组显示出较高的失血性休克发生率和外科ICU入院率。在创伤亚组和非创伤亚组中，EPO给药与较低的晚期红细胞输血需求显著相关，比值比[95%可信区间]分别为0.29[0.10-0.85]和0.03[0.004-0.18]。在EPO亚组中，血红蛋白水平中位数上升了1.2 g/dL。Cox模型显示与第28天和第365天的死亡率有显著相关性。结论本研究支持重症贫血ICU患者给予EPO可减少晚期输血需求，可能提高生存率的假设。在ICU患者输血后系统使用促红细胞生成素值得进一步研究。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.