Lower hemoglobin transfusion trigger is associated with higher mortality in patients hospitalized with pneumonia

Patients hospitalized with pneumonia may require packed red blood cell (RBC) transfusion during their hospital stay. Patient survival may be associated with the transfusion trigger. These patients may need a higher hemoglobin (Hb) trigger than that suggested by the AABB guidelines (7g/dL). The objective of this study was to evaluate the association between the initial transfusion Hb trigger and in-hospital mortality. A historical cohort study of all patients hospitalized in an internal medicine ward between 2009 and 2014 with pneumonia, who received at least 1 unit of RBC, was evaluated. The primary outcome was all-cause in-hospital mortality. One hundred males and 77 females with a median age of 80 (interquartile range 71-87) years were included. The median Hb trigger was 8.10g/dL. Mortality rate was 56% in patients with Hb trigger ≤7g/dL, 43.8% in Hb trigger 7 to 8g/dL, and 29.5% in Hb trigger >8g/dL (P=.045). Patients in the 3 Hb trigger categories did not differ in age, sex, comorbidities, albumin, creatinine, C-reactive protein, white blood cells, and platelet counts. The result of a multivariate analysis showed that only lower Hb trigger (odds ratio [OR] _{≤ 7vs.>8} =5.24, OR _7-8vs.>8 =2.13, P=.035) and higher neutrophil count (P=.012) were associated with increased in-hospital mortality. In conclusion, a lower transfusion trigger is associated with increased risk for in-hospital mortality in patients hospitalized with pneumonia requiring RBC transfusion.