Blood transfusions are associated with increased risk for development of sepsis in severely burned pediatric patients

Marc G. Jeschke, David L. Chinkes, Celeste Finnerty, Rene Przkora, Clifford T. Pereira, David Herndon

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

OBJECTIVE: To determine the risk of developing sepsis following transfusion of blood products in severely burned pediatric patients. DESIGN: Retrospective, cohort study. SETTING: Shriners Hospital for Children and University Hospital. PATIENTS: Severely burned pediatric patients with >30% total body surface area (TBSA) burn. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred seventy-seven pediatric burn patients over a period of 7 yrs (1997-2004) were included in the study, with 25 patients being septic at admission and therefore excluded. Patients were stratified according to TBSA burn and presence or absence of inhalation injury. The amounts of packed red blood cells (RBCs) and fresh frozen plasma (FFP) were recorded during hospital stay before the development of sepsis. Blood product administration was normalized for the number of surgeries and divided into two groups: high (RBCs >20/FFP >5) or low (RBCs <20/FFP <5) amount of blood products. Sepsis was diagnosed based on the criteria set by the Society of Critical Care Medicine in conjunction with positive blood culture or presence of organisms in the organs at autopsy. By stratifying the groups into low and high blood transfusion, we found that patients with >60% TBSA burn with inhalation injury have an 8% risk of developing sepsis in the low RBC group, which increases to 58% in the high RBC group (p < .05). Similar results were found for RBCs per operation, FFP, and FFP per operation (p < .05). There were no differences in age and gender between groups. CONCLUSIONS: Pediatric burn suffering from a 60% TBSA burn with concomitant inhalation injury are more likely to develop sepsis if they are given high amounts of blood products, indicating an immunocompromised state following blood transfusion.

Original languageEnglish (US)
Pages (from-to)579-583
Number of pages5
JournalCritical Care Medicine
Volume35
Issue number2
DOIs
StatePublished - Feb 2007

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Blood Transfusion
Sepsis
Erythrocytes
Body Surface Area
Pediatrics
Blood Group Antigens
Inhalation
Wounds and Injuries
Inhalation Burns
Psychological Stress
Length of Stay
Cohort Studies
Retrospective Studies

Keywords

  • Burn
  • Cytokines
  • Inflammation
  • Pediatric
  • Sepsis
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Blood transfusions are associated with increased risk for development of sepsis in severely burned pediatric patients. / Jeschke, Marc G.; Chinkes, David L.; Finnerty, Celeste; Przkora, Rene; Pereira, Clifford T.; Herndon, David.

In: Critical Care Medicine, Vol. 35, No. 2, 02.2007, p. 579-583.

Research output: Contribution to journalArticle

Jeschke, Marc G. ; Chinkes, David L. ; Finnerty, Celeste ; Przkora, Rene ; Pereira, Clifford T. ; Herndon, David. / Blood transfusions are associated with increased risk for development of sepsis in severely burned pediatric patients. In: Critical Care Medicine. 2007 ; Vol. 35, No. 2. pp. 579-583.
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abstract = "OBJECTIVE: To determine the risk of developing sepsis following transfusion of blood products in severely burned pediatric patients. DESIGN: Retrospective, cohort study. SETTING: Shriners Hospital for Children and University Hospital. PATIENTS: Severely burned pediatric patients with >30{\%} total body surface area (TBSA) burn. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred seventy-seven pediatric burn patients over a period of 7 yrs (1997-2004) were included in the study, with 25 patients being septic at admission and therefore excluded. Patients were stratified according to TBSA burn and presence or absence of inhalation injury. The amounts of packed red blood cells (RBCs) and fresh frozen plasma (FFP) were recorded during hospital stay before the development of sepsis. Blood product administration was normalized for the number of surgeries and divided into two groups: high (RBCs >20/FFP >5) or low (RBCs <20/FFP <5) amount of blood products. Sepsis was diagnosed based on the criteria set by the Society of Critical Care Medicine in conjunction with positive blood culture or presence of organisms in the organs at autopsy. By stratifying the groups into low and high blood transfusion, we found that patients with >60{\%} TBSA burn with inhalation injury have an 8{\%} risk of developing sepsis in the low RBC group, which increases to 58{\%} in the high RBC group (p < .05). Similar results were found for RBCs per operation, FFP, and FFP per operation (p < .05). There were no differences in age and gender between groups. CONCLUSIONS: Pediatric burn suffering from a 60{\%} TBSA burn with concomitant inhalation injury are more likely to develop sepsis if they are given high amounts of blood products, indicating an immunocompromised state following blood transfusion.",
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AU - Jeschke, Marc G.

AU - Chinkes, David L.

AU - Finnerty, Celeste

AU - Przkora, Rene

AU - Pereira, Clifford T.

AU - Herndon, David

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N2 - OBJECTIVE: To determine the risk of developing sepsis following transfusion of blood products in severely burned pediatric patients. DESIGN: Retrospective, cohort study. SETTING: Shriners Hospital for Children and University Hospital. PATIENTS: Severely burned pediatric patients with >30% total body surface area (TBSA) burn. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred seventy-seven pediatric burn patients over a period of 7 yrs (1997-2004) were included in the study, with 25 patients being septic at admission and therefore excluded. Patients were stratified according to TBSA burn and presence or absence of inhalation injury. The amounts of packed red blood cells (RBCs) and fresh frozen plasma (FFP) were recorded during hospital stay before the development of sepsis. Blood product administration was normalized for the number of surgeries and divided into two groups: high (RBCs >20/FFP >5) or low (RBCs <20/FFP <5) amount of blood products. Sepsis was diagnosed based on the criteria set by the Society of Critical Care Medicine in conjunction with positive blood culture or presence of organisms in the organs at autopsy. By stratifying the groups into low and high blood transfusion, we found that patients with >60% TBSA burn with inhalation injury have an 8% risk of developing sepsis in the low RBC group, which increases to 58% in the high RBC group (p < .05). Similar results were found for RBCs per operation, FFP, and FFP per operation (p < .05). There were no differences in age and gender between groups. CONCLUSIONS: Pediatric burn suffering from a 60% TBSA burn with concomitant inhalation injury are more likely to develop sepsis if they are given high amounts of blood products, indicating an immunocompromised state following blood transfusion.

AB - OBJECTIVE: To determine the risk of developing sepsis following transfusion of blood products in severely burned pediatric patients. DESIGN: Retrospective, cohort study. SETTING: Shriners Hospital for Children and University Hospital. PATIENTS: Severely burned pediatric patients with >30% total body surface area (TBSA) burn. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred seventy-seven pediatric burn patients over a period of 7 yrs (1997-2004) were included in the study, with 25 patients being septic at admission and therefore excluded. Patients were stratified according to TBSA burn and presence or absence of inhalation injury. The amounts of packed red blood cells (RBCs) and fresh frozen plasma (FFP) were recorded during hospital stay before the development of sepsis. Blood product administration was normalized for the number of surgeries and divided into two groups: high (RBCs >20/FFP >5) or low (RBCs <20/FFP <5) amount of blood products. Sepsis was diagnosed based on the criteria set by the Society of Critical Care Medicine in conjunction with positive blood culture or presence of organisms in the organs at autopsy. By stratifying the groups into low and high blood transfusion, we found that patients with >60% TBSA burn with inhalation injury have an 8% risk of developing sepsis in the low RBC group, which increases to 58% in the high RBC group (p < .05). Similar results were found for RBCs per operation, FFP, and FFP per operation (p < .05). There were no differences in age and gender between groups. CONCLUSIONS: Pediatric burn suffering from a 60% TBSA burn with concomitant inhalation injury are more likely to develop sepsis if they are given high amounts of blood products, indicating an immunocompromised state following blood transfusion.

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