Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis - Scorecard - 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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Clinical Scorecard: The Impact of Red Blood Cell Transfusion on Clinical Outcomes Is Not Influenced by Cardiac History: Insights from a Multicenter Observational InPUT Study

At a Glance

CategoryDetail
ConditionAnaemia in critically ill patients with or without cardiac history
Key MechanismsRed blood cell transfusion to treat anaemia; assessment of association with 28-day composite outcome (death, acute kidney injury, ventilatory weaning failure)
Target PopulationCritically ill adult ICU patients, including those with acute coronary syndrome or heart failure history
Care SettingIntensive Care Units across multiple international centers

Key Highlights

  • RBC transfusion is common in ICU patients, often used to treat anaemia prevalent in up to 90% during ICU stay.
  • Up to 40% of ICU patients have a cardiac history (ACS or HF), with anaemia being an independent risk factor for hospitalization and mortality.
  • The study found no modification by cardiac history on the association between RBC transfusion and 28-day composite outcome of death, AKI, or ventilatory weaning failure.

Guideline-Based Recommendations

Diagnosis

  • Identify cardiac history as documented ACS or HF prior to ICU admission.
  • Define acute kidney injury by serum creatinine increase or urine output criteria.
  • Diagnose ventilatory weaning failure by failure of spontaneous breathing trial or reintubation within 48 hours.

Management

  • Apply restrictive RBC transfusion strategies for anaemia in critically ill patients.
  • Consider higher transfusion thresholds in acute cardiac conditions as per current guidelines, though evidence is inconclusive for pre-existing cardiac history.
  • Record haemoglobin thresholds and clinical indications for each RBC transfusion event.

Monitoring & Follow-up

  • Monitor nadir haemoglobin levels throughout ICU stay.
  • Track new-onset adverse events including ACS, AKI, sepsis, and ventilatory weaning failure.
  • Follow patients for up to 28 days for composite outcomes.

Risks

  • Anaemia is an independent risk factor for hospitalization and mortality in patients with cardiac history.
  • Non-adherence to restrictive transfusion strategies remains high, especially in patients with cardiac history.
  • Unclear impact of RBC transfusion on myocardial infarction or death at 30 days in patients with pre-existing cardiac conditions.

Patient & Prescribing Data

Adult ICU patients with and without cardiac history (ACS or HF)

RBC transfusion practices did not differ significantly in impact on 28-day composite outcomes based on cardiac history; restrictive transfusion strategies are supported but adherence is variable.

Clinical Best Practices

  • Use restrictive transfusion thresholds for anaemia management in ICU patients unless acute cardiac conditions warrant otherwise.
  • Carefully document cardiac history and clinical indications before RBC transfusion.
  • Monitor organ function and adverse events closely post-transfusion.
  • Apply standardized definitions for AKI and ventilatory weaning failure to guide clinical decisions.
  • Encourage adherence to evidence-based transfusion guidelines across ICU settings.

References

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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