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

Naomi Rahimi-Levene, Maya Koren-Michowitz, Ronit Zeidenstein, Victoria Peer, Ahuva Golik, Tomer Ziv-Baran

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article numbere0192
JournalMedicine (United States)
Issue number12
StatePublished - 1 Mar 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.


  • blood transfusion
  • mortality
  • pneumonia

ASJC Scopus subject areas

  • General Medicine


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