Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock
Open accessAbstract
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. (Funded by the Danish Strategic Research Council and others; TRISS ClinicalTrials.gov number, NCT01485315.).
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In the subgroup of 218 patients with sepsis or septic shock in the TRICC trial, 30-day mortality was similar between restrictive and liberal groups (22.8% vs 29.7%, p = 0.36).
“In the subgroup of 218 patients with sepsis or septic shock 30-day mortality was similar in the two groups (22.8% in the restrictive group vs. 29.7% in the liberal group, p = 0.36).”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [485]
In the TRICC trial, a restrictive transfusion threshold of 70 g/L versus 100 g/L in 838 euvolemic ICU patients showed no difference in 30-day mortality.
“The Transfusion requirements in in Critical Care trial (TRICC), which compared a restrictive transfusion threshold of 70 g/L versus 100 g/L in 838 euvolemic ICU patients, demonstrated no difference in the primary outcome (30-day mortality).”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [485]
In the TRISS trial, a transfusion threshold of 70 g/L versus 90 g/L in 1000 septic shock patients after ICU admission resulted in similar 90-day mortality, ischaemic events, and use of life support, with fewer transfusions in the lower-threshold group.
“The results showed similar 90-day mortality, ischaemic events, and use of life support in the two treatment groups with fewer transfusions in the lower-threshold group.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [485]
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References 46 · Cited by 899
Research works printed but not linked: 1
- Vincent JL, Moreno R, Takala J, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dys- function/failure. Intensive Care Med 1996; 22:707-10.
- Authors
- Holst, L. B., Haase, N., Wetterslev, J., Wernerman, J., Guttormsen, A. B., Karlsson, S., Johansson, P. I., Åneman, A., Vang, M. L., Winding, R., Nebrich, L., Nibro, H. L., Rasmussen, B. S., Lauridsen, J. R. M., Nielsen, J. S., Oldner, A., Pettilä, V., Cronhjort, M. B., Andersen, L. H., Pedersen, U. G., Reiter, N., Wiis, J., White, J. O., Russell, L., Thornberg, K. J., Hjortrup, P. B., Müller, R. G., Møller, M. H., Steensen, M., Tjäder, I., Kilsand, K., Odeberg-Wernerman, S., Sjøbø, B., Bundgaard, H., Thyø, M. A., Lodahl, D., Mærkedahl, R., Albeck, C., Illum, D., Kruse, M., Winkel, P., & Perner, A.
- Affiliations
- University of Copenhagen (DK)
- Rigshospitalet (DK)
- Karolinska University Hospital (SE)
- Regional Hospital Randers (DK)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-10-09
- Volume
- 371
- Issue
- 15
- Pages
- 1381-1391
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2169558208
- Cited by
- 899
- References
- 46
- Citations by year
- 2026: 41 · 2025: 47 · 2024: 61 · 2023: 46 · 2022: 42 · 2021: 63 · 2020: 85 · 2019: 92 · 2018: 80 · 2017: 107 · 2016: 104 · 2015: 111 · 2014: 15 · 2013: 1
- FWCI
- 78.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Keywords
- septic shock, blood transfusion, hemoglobin threshold, intensive care unit, mortality, ischemic events, life support, transfusion timing
- MeSH terms
- Aged, Female, Hemoglobins, Humans, Intensive Care Units, Ischemia, Male, Middle Aged, Risk, Shock, Septic, Single-Blind Method, Myocardial Ischemia, Erythrocyte Transfusion, Kaplan-Meier Estimate
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