Aim for Hb 7 or 9g/dl?

Holst2014-header

In the TRISS study, Holst and colleagues completed a Scandanavian multicenter, randomized, parallel-group trial in 1,005 patients (998 analyzed) with septic shock and a haemoglobin concentration ≤ 9g/dL, comparing a red cell transfusion trigger of ≤ 7g/dL with ≤ 9g/dL and found:

  • There was NO statistically significant difference in (7g/dl Vs 9g/dl) :
    • 90 day mortality (43% vs 45%; RR 0.94; 95% CI 0.78 to 1.09; P = 0.44)
    • Ischemic events (7.2% vs 8%, RR 0.90, 95% CI 0.58 to 1.39, P=0.64)
    • Requiring life support at day (14: 36.8% vs 36.8%, RR 0.99, 95% 0.81 to 1.19; P=0.95)
    • Alive without renal-replacement therapy (mean % of days) 85% vs 83%; P=0.54
    • Alive and out of the hospital (mean % of days) 30% vs 31%; P=0.89
  • But the higher transfusion trigger group did receive more blood (funnily enough)

 

The full text is available via NEJM.

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