Outcomes Associated With Early RBC Transfusion in Pediatric Severe Sepsis: A Propensity-Adjusted Multicenter Cohort Study

Jennifer A. Muszynski, Russell Banks, Ron W. Reeder, Mark W. Hall, Robert A. Berg, Athena Zuppa, Thomas P. Shanley, Timothy T. Cornell, Christopher J.L. Newth, Murray M. Pollack, David Wessel, Allan Doctor, John C. Lin, Rick E. Harrison, Kathleen L. Meert, J. Michael Dean, Richard Holubkov, Joseph A. Carcillo

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background:Little is known about the epidemiology of and outcomes related to red blood cell (RBC) transfusion in septic children across multiple centers. We performed propensity-adjusted secondary analyses of the Biomarker Phenotyping of Pediatric Sepsis and Multiple Organ Failure (PHENOMS) study to test the hypothesis that early RBC transfusion is associated with fewer organ failure-free days in pediatric severe sepsis.Methods:Four hundred one children were enrolled in the parent study. Children were excluded from these analyses if they received extracorporeal membrane oxygenation (n = 22) or died (n = 1) before sepsis day 2. Propensity-adjusted analyses compared children who received RBC transfusion on or before sepsis day 2 (early RBC transfusion) with those who did not. Logistic regression was used to model the propensity to receive early RBC transfusion. A weighted cohort was constructed using stabilized inverse probability of treatment weights. Variables in the weighted cohort with absolute standardized differences >0.15 were added to final multivariable models.Results:Fifty percent of children received at least one RBC transfusion. The majority (68%) of first transfusions were on or before sepsis day 2. Early RBC transfusion was not independently associated with organ failure-free (-0.34 [95%CI: -2, 1.3] days) or PICU-free days (-0.63 [-2.3, 1.1]), but was associated with the secondary outcome of higher mortality (aOR 2.9 [1.1, 7.9]).Conclusions:RBC transfusion is common in pediatric severe sepsis and may be associated with adverse outcomes. Future studies are needed to clarify these associations, to understand patient-specific transfusion risks, and to develop more precise transfusion strategies.

Original languageEnglish
Pages (from-to)88-94
Number of pages7
Issue number1
StatePublished - Jan 1 2022


  • Blood transfusion
  • multiple organ failure
  • pediatric
  • sepsis


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