Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis

Antoine Kimmoun; Nicolas Girerd; InPUT Study Group; Kevin Duarte; Jolie Bruno; Jimmy Schenk; Bruno Levy; Guillaume Baudry; Senta Jorinde Raasveld; Sanne de Bruin; Merijn C. Reuland; Claudia van den Oord; Caroline M. Schaap; Jan Bakker; Maurizio Cecconi; Aarne Feldheiser; Jens Meier; Zoe McQuilten; Marcella C.A. Müller; Thomas W.L. Scheeren; Cécile Aubron; Andrew W.J. Flint; Tarikul Hamid; Michaël Piagnerelli; Tina Tomić Mahečić; Jan Benes; Lene Russell; Hernán Aguirre-Bermeo; Konstantina Triantafyllopoulou; Vasiliki Chantziara; Mohan Gurjar; Sheila Nainan Myatra; Vincenzo Pota; Muhammed Elhadi; Ryszard Gawda; Mafalda Mourisco; Marcus Lance; Vojislava Neskovic; Matej Podbregar; Juan V. Llau; Manual Quintana-Diaz; Maria Cronhjort; Carmen A. Pfortmueller; Nihan Yapici; Nathan Nielsen; Akshay Shah; Harm Jan de Grooth; Alexander Vlaar; Alexandre Mebazaa

doi:10.1186/s13054-025-05745-5

Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis

Antoine Kimmoun^*
, Nicolas Girerd
, InPUT Study Group
, Kevin Duarte
, Jolie Bruno
, Jimmy Schenk
, Bruno Levy
, Guillaume Baudry
, Senta Jorinde Raasveld
, Sanne de Bruin
, Merijn C. Reuland
, Claudia van den Oord
, Caroline M. Schaap
, Jan Bakker
, Maurizio Cecconi
, Aarne Feldheiser
, Jens Meier
, Zoe McQuilten
, Marcella C.A. Müller
, Thomas W.L. Scheeren

Cécile Aubron, Andrew W.J. Flint, Tarikul Hamid, Michaël Piagnerelli, Tina Tomić Mahečić, Jan Benes, Lene Russell, Hernán Aguirre-Bermeo, Konstantina Triantafyllopoulou, Vasiliki Chantziara, Mohan Gurjar, Sheila Nainan Myatra, Vincenzo Pota, Muhammed Elhadi, Ryszard Gawda, Mafalda Mourisco, Marcus Lance, Vojislava Neskovic, Matej Podbregar, Juan V. Llau, Manual Quintana-Diaz, Maria Cronhjort, Carmen A. Pfortmueller, Nihan Yapici, Nathan Nielsen, Akshay Shah, Harm Jan de Grooth, Alexander Vlaar, Alexandre Mebazaa

^*Corresponding author for this work

Université de Lorraine
Université Paris Cité
Assistance publique – Hôpitaux de Paris
Amsterdam UMC
Pontificia Universidad Católica de Chile
IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
EvangKliniken Essen-Mitte
Kepler University Hospital GmbH and Johannes Kepler University
Monash University
University Medical Centre Groningen
Université de Bretagne Occidentale
Asgar Ali Hospital
Université libre de Bruxelles
University of Zagreb
Charles University
Rigshospitalet
Copenhagen University Hospital (Nordvest)
University of Copenhagen
Hospital Vicente Corral Moscoso
European Interbalkan Medical Center
National and Kapodistrian University of Athens
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Tata Memorial Hospital
University of Campania Luigi Vanvitelli
University of Tripoli
University of Opole
Centro Hospitalar de Entro o Douro e Vouga
Aga Khan University
Military Medical Academy
Institute for Economic Research
Hospital Universitario Dr. Peset
Hospital Universitario La Paz
Karolinska Institutet
University of Bern
University of Health Sciences
University of New Mexico
University of Oxford
Amsterdam UMC, Locatie VUmc
Paris University

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

23 Downloads (Pure)

Abstract

Purpose:

Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce.

Methods:

Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested.

Results:

Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44).

Conclusions:

RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. Trial registration: NL9049 (Dutch Trial Register), registered on 16 November 2020.

Original language	English
Article number	526
Journal	Critical Care
Volume	29
Issue number	1
DOIs	https://doi.org/10.1186/s13054-025-05745-5
Publication status	Published - 18 Dec 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025.

Access to Document

10.1186/s13054-025-05745-5Licence: CC BY-NC-ND

Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac historyFinal published version, 2.18 MBLicence: CC BY-NC-ND

Cite this

Kimmoun, A., Girerd, N., InPUT Study Group, Duarte, K., Bruno, J., Schenk, J., Levy, B., Baudry, G., Raasveld, S. J., de Bruin, S., Reuland, M. C., van den Oord, C., Schaap, C. M., Bakker, J., Cecconi, M., Feldheiser, A., Meier, J., McQuilten, Z., Müller, M. C. A., ... Mebazaa, A. (2025). Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis. Critical Care, 29(1), Article 526. https://doi.org/10.1186/s13054-025-05745-5

@article{cd2fc63147ae4391ad32c0f466599614,

title = "Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis",

abstract = "Purpose: Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. Methods: Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. Results: Cardiac history was present in 746 of 3643 patients (20\%) and 894 of 3643 (25\%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25\% vs. 24\%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95\% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). Conclusions: RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. Trial registration: NL9049 (Dutch Trial Register), registered on 16 November 2020.",

author = "Antoine Kimmoun and Nicolas Girerd and \{InPUT Study Group\} and Kevin Duarte and Jolie Bruno and Jimmy Schenk and Bruno Levy and Guillaume Baudry and Raasveld, \{Senta Jorinde\} and \{de Bruin\}, Sanne and Reuland, \{Merijn C.\} and \{van den Oord\}, Claudia and Schaap, \{Caroline M.\} and Jan Bakker and Maurizio Cecconi and Aarne Feldheiser and Jens Meier and Zoe McQuilten and M{\"u}ller, \{Marcella C.A.\} and Scheeren, \{Thomas W.L.\} and C{\'e}cile Aubron and Flint, \{Andrew W.J.\} and Tarikul Hamid and Micha{\"e}l Piagnerelli and Mahe{\v c}i{\'c}, \{Tina Tomi{\'c}\} and Jan Benes and Lene Russell and Hern{\'a}n Aguirre-Bermeo and Konstantina Triantafyllopoulou and Vasiliki Chantziara and Mohan Gurjar and Myatra, \{Sheila Nainan\} and Vincenzo Pota and Muhammed Elhadi and Ryszard Gawda and Mafalda Mourisco and Marcus Lance and Vojislava Neskovic and Matej Podbregar and Llau, \{Juan V.\} and Manual Quintana-Diaz and Maria Cronhjort and Pfortmueller, \{Carmen A.\} and Nihan Yapici and Nathan Nielsen and Akshay Shah and \{de Grooth\}, \{Harm Jan\} and \{van Bochove\}, Victor and \{van Wonderen\}, Stefan and Nicole Juffermans and Yan Chen and Alexander Vlaar and Alexandre Mebazaa",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = dec,

day = "18",

doi = "10.1186/s13054-025-05745-5",

language = "English",

volume = "29",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd.",

number = "1",

}

Kimmoun, A, Girerd, N, InPUT Study Group, Duarte, K, Bruno, J, Schenk, J, Levy, B, Baudry, G, Raasveld, SJ, de Bruin, S, Reuland, MC, van den Oord, C, Schaap, CM, Bakker, J, Cecconi, M, Feldheiser, A, Meier, J, McQuilten, Z, Müller, MCA, Scheeren, TWL, Aubron, C, Flint, AWJ, Hamid, T, Piagnerelli, M, Mahečić, TT, Benes, J, Russell, L, Aguirre-Bermeo, H, Triantafyllopoulou, K, Chantziara, V, Gurjar, M, Myatra, SN, Pota, V, Elhadi, M, Gawda, R, Mourisco, M, Lance, M, Neskovic, V, Podbregar, M, Llau, JV, Quintana-Diaz, M, Cronhjort, M, Pfortmueller, CA, Yapici, N, Nielsen, N, Shah, A, de Grooth, HJ, Vlaar, A & Mebazaa, A 2025, 'Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis', Critical Care, vol. 29, no. 1, 526. https://doi.org/10.1186/s13054-025-05745-5

TY - JOUR

T1 - Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history

T2 - a multicenter observational InPUT study analysis

AU - Kimmoun, Antoine

AU - Girerd, Nicolas

AU - InPUT Study Group

AU - Duarte, Kevin

AU - Bruno, Jolie

AU - Schenk, Jimmy

AU - Levy, Bruno

AU - Baudry, Guillaume

AU - Raasveld, Senta Jorinde

AU - de Bruin, Sanne

AU - Reuland, Merijn C.

AU - van den Oord, Claudia

AU - Schaap, Caroline M.

AU - Bakker, Jan

AU - Cecconi, Maurizio

AU - Feldheiser, Aarne

AU - Meier, Jens

AU - McQuilten, Zoe

AU - Müller, Marcella C.A.

AU - Scheeren, Thomas W.L.

AU - Aubron, Cécile

AU - Flint, Andrew W.J.

AU - Hamid, Tarikul

AU - Piagnerelli, Michaël

AU - Mahečić, Tina Tomić

AU - Benes, Jan

AU - Russell, Lene

AU - Aguirre-Bermeo, Hernán

AU - Triantafyllopoulou, Konstantina

AU - Chantziara, Vasiliki

AU - Gurjar, Mohan

AU - Myatra, Sheila Nainan

AU - Pota, Vincenzo

AU - Elhadi, Muhammed

AU - Gawda, Ryszard

AU - Mourisco, Mafalda

AU - Lance, Marcus

AU - Neskovic, Vojislava

AU - Podbregar, Matej

AU - Llau, Juan V.

AU - Quintana-Diaz, Manual

AU - Cronhjort, Maria

AU - Pfortmueller, Carmen A.

AU - Yapici, Nihan

AU - Nielsen, Nathan

AU - Shah, Akshay

AU - de Grooth, Harm Jan

AU - van Bochove, Victor

AU - van Wonderen, Stefan

AU - Juffermans, Nicole

AU - Chen, Yan

AU - Vlaar, Alexander

AU - Mebazaa, Alexandre

PY - 2025/12/18

Y1 - 2025/12/18

N2 - Purpose: Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. Methods: Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. Results: Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). Conclusions: RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. Trial registration: NL9049 (Dutch Trial Register), registered on 16 November 2020.

AB - Purpose: Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. Methods: Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. Results: Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). Conclusions: RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. Trial registration: NL9049 (Dutch Trial Register), registered on 16 November 2020.

UR - https://www.scopus.com/pages/publications/105025263135

U2 - 10.1186/s13054-025-05745-5

DO - 10.1186/s13054-025-05745-5

M3 - Article

C2 - 41413913

AN - SCOPUS:105025263135

SN - 1364-8535

VL - 29

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 526

ER -

Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this