Impact of allogeneic blood transfusions on clinical outcomes in severely burned patients

Alexander Kaserer; Julian Rössler; Ksenija Slankamenac; Michael Arvanitakis; Donat R Spahn; Pietro Giovanoli; Peter Steiger; Jan A Plock

doi:10.1016/j.burns.2019.11.005

Impact of allogeneic blood transfusions on clinical outcomes in severely burned patients

Burns. 2020 Aug;46(5):1083-1090. doi: 10.1016/j.burns.2019.11.005. Epub 2019 Dec 19.

Authors

Alexander Kaserer¹, Julian Rössler¹, Ksenija Slankamenac², Michael Arvanitakis³, Donat R Spahn¹, Pietro Giovanoli³, Peter Steiger⁴, Jan A Plock⁵

Affiliations

¹ Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
² Emergency Department, University Hospital Zurich, Zurich, Switzerland.
³ Department of Plastic Surgery and Hand Surgery, Burn Center, University and University Hospital Zurich, Zurich, Switzerland.
⁴ Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
⁵ Department of Plastic Surgery and Hand Surgery, Burn Center, University and University Hospital Zurich, Zurich, Switzerland. Electronic address: jan.plock@usz.ch.

PMID: 31866181
DOI: 10.1016/j.burns.2019.11.005

Abstract

Background: Allogeneic blood transfusions are common in the treatment of severely burned patients as surgery may lead to major blood loss. However, transfusions are associated with a number of adverse events. Therefore, the purpose of our study was to investigate the impact of allogeneic blood transfusions on clinical outcomes in severely burned patients.

Methods: This retrospective study included all adult patients admitted to the burn center of the University Hospital Zurich between January 2004 and December 2014, with burn injuries greater than 10% of total body surface area and receiving both surgical and intensive care treatment. Primary Endpoints were infectious or thromboembolic complications and mortality and secondary endpoints were length of hospital and ICU stay. Simple and multivariable logistic and linear regression models, adjusted for injury severity and confounders, were applied.

Results: 413 patients met inclusion criteria of which 212 patients (51%) received allogenic blood products. After adjustment for injury severity and confounders, red blood cell transfusion was independently associated with wound infection (OR 13.5, 95% CI 1.7-107, p = 0.014), sepsis (OR 8.3, 4.2-16.3; p < 0.001), pneumonia (OR 4.7, 2.2-10.0; p < 0.001), thrombosis (OR 3.0, 1.2-7.4; p = 0.015), central line infection (OR 34.7, 4.6-260; p = 0.001) and a longer ICU and hospital stay (difference 17.7, CI 12.1-23.4, p < 0.001 and 22.0, 15.8-28.2, p < 0.001, respectively). Fresh frozen plasma transfusion was independently associated with a longer ICU and hospital stay (difference 13.7, 95% CI 5.5-21.8, p = 0.001 and 13.5, 4.6-22.5, p = 0.003, respectively). Platelet transfusion was independently associated with systemic inflammatory response syndrome (OR 4.5, 1.3-15.5; p = 0.018) and mortality (OR 5.8, 2.1-16.0; p = 0.001).

Conclusion: Transfusion of allogeneic blood products is associated with an increased infection rate and thromboembolic morbidity and a longer hospital stay in severely burned patients.

Keywords: Blood products; Burn; Infections; Morbidity; Mortality; Thromboembolic events.

MeSH terms

Adult
Anemia / therapy*
Blood Transfusion / statistics & numerical data*
Body Surface Area
Burns / pathology
Burns / surgery*
Catheter-Related Infections / epidemiology
Central Venous Catheters
Erythrocyte Transfusion / statistics & numerical data
Female
Hospital Mortality*
Humans
Infections / epidemiology*
Intensive Care Units
Length of Stay / statistics & numerical data*
Male
Middle Aged
Plasma
Platelet Transfusion / statistics & numerical data
Pneumonia / epidemiology
Sepsis / epidemiology
Systemic Inflammatory Response Syndrome / epidemiology*
Thrombosis / epidemiology*
Transfusion Reaction
Transplantation, Homologous
Wound Infection / epidemiology