Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda
Background: Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-06-01
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| Series: | African Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X20300057 |
| _version_ | 1828387450621263872 |
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| author | Katelyn Moretti Catalina González Marqués Stephanie Garbern Gabin Mbanjumucyo Chantal Uwamahoro Francesca L. Beaudoin Siraj Amanullah Annie Gjelsvik Adam R. Aluisio |
| author_facet | Katelyn Moretti Catalina González Marqués Stephanie Garbern Gabin Mbanjumucyo Chantal Uwamahoro Francesca L. Beaudoin Siraj Amanullah Annie Gjelsvik Adam R. Aluisio |
| author_sort | Katelyn Moretti |
| collection | DOAJ |
| description | Background: Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. Methods: This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013–16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. Results: Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p = 0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51–3.21) as compared to those ≤5.0 mg/dL. Conclusions: No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice. |
| first_indexed | 2024-12-10T05:53:32Z |
| format | Article |
| id | doaj.art-8965f55b25d248cb9a9f8b9887278933 |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-12-10T05:53:32Z |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-8965f55b25d248cb9a9f8b98872789332022-12-22T01:59:59ZengElsevierAfrican Journal of Emergency Medicine2211-419X2020-06-011026873Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, RwandaKatelyn Moretti0Catalina González Marqués1Stephanie Garbern2Gabin Mbanjumucyo3Chantal Uwamahoro4Francesca L. Beaudoin5Siraj Amanullah6Annie Gjelsvik7Adam R. Aluisio8Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA; Brown University School of Public Health, Providence, USA; Corresponding author.Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USADepartment of Emergency Medicine, Brown University Alpert Medical School, Providence, USADepartment of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda; University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; Service d'Aide Médicale Urgente, Kigali, RwandaDepartment of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda; University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; Service d'Aide Médicale Urgente, Kigali, RwandaDepartment of Emergency Medicine, Brown University Alpert Medical School, Providence, USADepartment of Emergency Medicine, Brown University Alpert Medical School, Providence, USABrown University School of Public Health, Providence, USADepartment of Emergency Medicine, Brown University Alpert Medical School, Providence, USABackground: Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. Methods: This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013–16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. Results: Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p = 0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51–3.21) as compared to those ≤5.0 mg/dL. Conclusions: No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice.http://www.sciencedirect.com/science/article/pii/S2211419X20300057BloodTransfusionMortalityRwandaLMICEmergency |
| spellingShingle | Katelyn Moretti Catalina González Marqués Stephanie Garbern Gabin Mbanjumucyo Chantal Uwamahoro Francesca L. Beaudoin Siraj Amanullah Annie Gjelsvik Adam R. Aluisio Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda African Journal of Emergency Medicine Blood Transfusion Mortality Rwanda LMIC Emergency |
| title | Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda |
| title_full | Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda |
| title_fullStr | Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda |
| title_full_unstemmed | Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda |
| title_short | Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda |
| title_sort | transfusion mortality and hemoglobin level associations among emergency department patients in kigali rwanda |
| topic | Blood Transfusion Mortality Rwanda LMIC Emergency |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X20300057 |
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