No benefit with transfusion of fresh red cells compared with older red cells in critically ill patients

Reference

Cooper DJ, McQuilten ZK, Nichol A, et al, for the TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Age of red cells for transfusion and outcomes in critically ill adults. N Engl J Med 2017;377(19):1858-1867.

Synopsis

Using concealed allocation, these investigators randomized adult patients in an intensive care unit (ICU) who required transfusion to receive either the freshest red cells available (short-term storage group) or the standard-issue oldest available red cells (long-term storage group). Patients continued to receive red cells according to their initial treatment assignment throughout their hospital stay even after discharge from the ICU. The collection and expiration dates of red cells were concealed using opaque labels so that patients and treating staff were masked to the treatment group assignments. After excluding 75 patients who either withdrew consent or were lost to follow-up, 2457 patients in the short-term storage group and 2462 patients in the long-term storage group were included in the primary analysis. Patients in the short-term storage group were older by 1 year, but baseline characteristics were otherwise similar, with a mean age of 62 years and a baseline hemoglobin level of 7.7 g/dL. For the primary outcome of 90-day mortality, there was no significant difference detected between the 2 groups. Similarly, there were no differences in secondary outcomes, including rate of organ dysfunction or death at 28 days, new bloodstream infections, need for mechanical ventilation or renal-replacement therapy, or ICU length of stay. Among patients who were sicker (as demonstrated by a higher Acute Physiology and Chronic Health Evaluation III [APACHE III] score), those who received fresh red cells actually had higher mortality (odds ratio 1.18; 95% CI 1.00 - 1.39; P = .05).