12/2/2014 – Review: Lower versus higher hemoglobin threshold for transfusion in septic shock.


Holst LB et al: Lower versus higher hemoglobin threshold for transfusion in septic shock. NEJM 2014; 371:1381-91.
The TRISS Trial (Transfusion Requirements in Septic Shock) enrolled just over 1,000 patients who were randomized to hemoglobin transfusion triggers of 7 vs. 9 g/dL. Patients in the 7 g/dL group received half as many RBC units, and had similar mortality at 90 days, similar use of life support (vasopressors, inotropes, mechanical ventilation and renal replacement therapy), as well as a similar number of days alive and out of the hospital. This study represents the 7th large randomized trial demonstrating that a liberal transfusion strategy based on a higher hemoglobin trigger does not improve outcome. We now have evidence in the following patient populations supporting this finding: 1) critically ill ICU patients, 2) critically ill pediatric ICU patients, 3) postoperative cardiac surgery patients, 4) gastrointestinal bleeding patients, 5) traumatic brain injury patients, 6) elderly orthopedic patients with cardiovascular disease, and 7) patients with septic shock. The TRISS Trial should be considered to be one of the landmark studies supporting the goals of patient blood management programs.

Steven M. Frank M.D.
Associate Professor Director, Johns Hopkins Health System Blood Management Program
Director, Center for Bloodless Medicine and Surgery
Department of Anesthesiology/Critical Care Medicine
Johns Hopkins Medical Institutions