RBC Transfusion Outcomes Similar in ICU Patients with and Without Cardiovascular Disease

In intensive care units (ICU), 25%-50% of patients receive RBC transfusions. Up to 30-40% of ICU patients also have a history of cardiovascular disease. Although current transfusion guidelines recommend higher transfusion thresholds for acute cardiac patients, data on RBC transfusions for ICU patients with pre-existing cardiac conditions are limited. Based on observational data from the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices (InPUT) cohort from 233 centers in 30 countries from six continents, researchers examined clinical outcomes after RBC transfusions in ICU patients with and without a history of cardiovascular disease. Briefly, all adult ICU patients admitted during one week at each center were followed for 28-days or until death or discharge. Of 3,643 ICU patients, 20% had a history of cardiovascular disease and 25% received at least one RBC unit. In patients with and without a history of cardiovascular disease, transfusion rates (25% and 24%), transfusion thresholds (8.5 g/dL and 8.0 g/dL), and the total number of RBC units transfused (both 2 units) were similar, respectively. Based on weighted logistic regression, each additional unit of RBCs increased the odds of death or organ dysfunction (OR, 2.18; 95% C.I., 1.85 to 2.56) regardless of cardiac history. As transfusion threshold data for patients with acute myocardial infarction and preexisting cardiovascular disease have recently changed, it will be important to continue to monitor ICU patients.  A personalized approach to transfusions for patients in the ICU may be beneficial.

Reference:

Kimmoun A, Girerd N, Duarte K, Bruno J, et al; InPUT study Group. Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis. Crit Care. 2025 Dec 18;29(1):526. doi: 10.1186/s13054-025-05745-5. PMID: 41413913; PMCID: PMC12713240.