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

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

  • By

  • Antoine Kimmoun

  • Nicolas Girerd

  • 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

  • Hernan 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 P. J. Vlaar

  • Alexandre Mebazaa

  • December 18, 2025

  • 0 min

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RBC Transfusion Impact on Outcomes Unaffected by Cardiac History: InPUT Study Insights

Overview

This multicenter observational study evaluated the influence of cardiac history on the association between red blood cell (RBC) transfusion and 28-day clinical outcomes in ICU patients. Findings indicate that cardiac history, including acute coronary syndrome (ACS) or heart failure (HF), does not modify the relationship between RBC transfusion and a composite endpoint of death, acute kidney injury, or ventilatory weaning failure.

Background

Red blood cell transfusion is a common intervention in intensive care units, primarily used to treat anemia, which affects a majority of critically ill patients. Although restrictive transfusion strategies are generally recommended, adherence is low, especially in patients with cardiac history such as ACS or HF. These patients represent up to 40% of ICU admissions and have a high prevalence of anemia, which is an independent risk factor for adverse outcomes. Current guidelines suggest higher transfusion thresholds for acute cardiac conditions, but evidence regarding patients with pre-existing cardiac history remains limited.

Data Highlights

The InPUT study enrolled adult ICU patients across 233 centers in 30 countries from 2019 to 2022. The primary composite outcome included death, acute kidney injury (AKI), or ventilatory weaning failure (VWF) within 28 days. Cardiac history was defined as documented ACS or HF prior to ICU admission. The study analyzed transfusion indications, hemoglobin thresholds, and outcomes in relation to cardiac history using mixed-effects models and imputation for missing data.

Key Findings

  • RBC transfusion was commonly administered to critically ill patients, with anemia being the primary indication.
  • Approximately 40% of patients had a documented cardiac history (ACS or HF) at ICU admission.
  • The association between RBC transfusion and the 28-day composite outcome of death, AKI, or VWF was not significantly modified by the presence of cardiac history.
  • No clear difference in transfusion practices or outcomes was observed between patients with ACS history versus those with HF history.
  • Restrictive transfusion strategies remain underutilized in patients with cardiac history despite guideline recommendations.

Clinical Implications

Clinicians can consider that the presence of a cardiac history should not alter the decision-making process regarding RBC transfusion thresholds in critically ill patients. Adherence to restrictive transfusion strategies appears safe and appropriate regardless of cardiac comorbidities. This supports uniform transfusion practices and may reduce unnecessary transfusions and associated risks in this population.

Conclusion

The InPUT study demonstrates that cardiac history does not influence the impact of RBC transfusion on key clinical outcomes in ICU patients. These findings support the application of restrictive transfusion strategies broadly, including in patients with pre-existing cardiac conditions.

References

  1. InPUT Study Group 2023 -- The Impact of Red Blood Cell Transfusion on Clinical Outcomes Is Not Influenced by Cardiac History

Original Source(s)

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

  • by Antoine Kimmoun, Nicolas Girerd, 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, Hernan 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 P. J. Vlaar, Alexandre Mebazaa

  • December 18, 2025

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