Andrew Shorr

Transient Abnormalities in Serum Bilirubin and Lactate Dehydrogenase Levels following Red Blood Cell Transfusions in Adults

BACKGROUND The effect of transfusion of small amounts of packed red blood cells (PRBC) on serum chemistry values is not known. METHODS We studied 73 adult patients without evidence of bleeding who received 2-unit PRBC transfusions. In study 1 (n=39), we examined multiple laboratory values pretransfusion and 15 minutes, 1 hour, 2 hours, and 24 hours posttransfusion. In study 2 (n=34), we examined changes in fractionated bilirubin, lactate dehydrogenase, and haptoglobin prior to and 1 hour following the transfusion. RESULTS Total bilirubin increased from a median pretransfusion baseline of 0.7 mg/dL to 1.4 mg/dL shortly after transfusion (P <0.0005), and then returned to normal 24 hours later. Of the 36 patients with normal pretreatment total bilirubin levels, 17 (47%) became transiently abnormal. The lactate dehydrogenase level increased similarly 15 minutes after transfusion, but returned to baseline 24 hours later. The unconjugated bilirubin level increased from a median baseline pretransfusion value of 0.3 mg/dL to 1.1 mg/dL at 1 hour posttransfusion (P <0.0005). No significant changes were noted in conjugated bilirubin levels or haptoglobin concentration following transfusion. CONCLUSIONS Transient increases in serum bilirubin and lactate dehydrogenase are seen following transfusion of PRBC. These data should be considered when interpreting laboratory values during the first few hours after a transfusion.

1460: EPIDEMIOLOGY AND OUTCOMES OF SEPSIS-ASSOCIATED COAGULOPATHY IN SEVERE SEPSIS AND SEPTIC SHOCK

Crit Care Med 2016 • Volume 44 • Number 12 (Suppl.) and septic shock. This study was conducted to describe the clinical outcomes of adult patients with severe sepsis and septic shock supported by venoarterial (VA) ECMO. Methods: A retrospective observational study (Japan Septic Disseminated Intravascular Coagulation [JSEPTIC-DIC] study) of adult patients was conducted in severe sepsis admitted to 42 intensive care units (ICUs) between January 2011 and December 2013. In the present study, data for the patients with severe sepsis and septic shock supported by VA-ECMO were collected. We analyzed the patient demographics, comorbidities, APACHE II score, SIRS score, SOFA score, lactate levels, infection site, and complications. The primary outcome was survival to hospital discharge. Results: Of 3195 patients with severe sepsis and septic shock, only 30 received VA-ECMO support. Of these, 6 patients (20%) survived to hospital discharge. Age, APACHE II, SOFA, lactate level, and infection site showed no significant differences between the surviving and nonsurviving patients. The number of ICU-free days and respirator-free days was higher in the surviving than in the non-surviving patients (p=0.04 and p=0.01, respectively). However, the number of RRT-free days and vasopressor-free days was not significantly different between the surviving and non-surviving patients. The rate of bleeding complications did not significantly differ between the surviving and non-surviving patients, but the use of blood transfusion was higher in the surviving than in the non-surviving patients. Conclusions: VA-ECMO for severe sepsis and septic shock still has a poor outcome. In our study, there were no prognostic factors found to be associated with survival to hospital discharge.