Blood Transfusion Administration in Seriously Ill Patients

BACKGROUND: Administration of blood transfusion in seriously ill patients is highly variable. Limited data are available to guide transfusion decisions. OBJECTIVE: To explore characteristics of patients who received blood transfusions and decisions to forgo transfusions in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). DESIGN: Prospective study of preferences, decision-making, and outcomes. SETTING: Five teaching hospitals. PARTICIPANTS: 9105 patients aged 18 years and older meeting defined diagnostic and illness severity criteria. MEASUREMENT: Data included blood transfusions, demographic characteristics, diagnoses, comorbid conditions, acute physiology score (APS), nutritional support, and functional status before hospitalization. RESULTS: A total of 2863 patients (31.4%) received blood transfusions, usually early in their hospitalization. Transfused patients were more likely male (57.3%; P = .008), with a younger mean age (56 vs 64 years), significantly higher APS (P < .001), and significantly lower 2- and 6-month survival predictions (P < .001). The patients with acute respiratory failure or multiorgan system failure with sepsis (1714; 59.9% of all patients receiving transfusions), multiorgan system failure with malignancy (480, 16.8%), and cirrhosis (248, 8.7%) were more likely to receive blood than those with other diseases. Few patients made a decision not to receive blood before (5; 0.05%) or after (126; 1.4%) study entry. Most patients with decisions to forgo transfusions also had decisions against trying resuscitation. CONCLUSIONS: Most transfusions occurred in patients with acute respiratory or multiorgan system failure. Few patients decide to forgo transfusions. Additional investigation is necessary to evaluate blood transfusion practices in seriously ill patients.