Mortality-associated parameters with inflammatory anemia in patients with sepsis admitted to the ICU and blood transfusion effect

Background
Sepsis triggers a dysregulated immune response, leading to inflammation, organ failure, and potentially death. Inflammatory anemia is common in sepsis, characterized by reduced red blood cell production and iron sequestration due to chronic inflammation.


Aim
This study examines mortality-associated parameters in septic patients with inflammatory anemia and assesses the impact of blood transfusions on outcomes.


Patients and methods
A prospective cohort study was conducted in the ICU of Assiut University Hospital, involving 100 sepsis patients. Group I (n=50) received blood transfusions, while group II (n=50) did not. Data on demographics, clinical assessments, laboratory measurements, and outcomes were collected and analyzed.


Results
On day 1, group I had lower lactate (2.62 mmol/l) and soluble transferrin receptor (sTfR) levels (18.63 nmol/l) compared to group II (3.27 mmol/l and 21.9 nmol/l, P=0.038 and 0.009, respectively). By day 7, group I had significantly lower sTfR (18.36 nmol/l), ferritin (70.85 ng/ml), and interleukin-6 (39.6 pg/ml) compared to group II (22.19 nmol/l, 140.23 ng/ml, and 53.96 pg/ml, P=0.009 and 0.042, respectively). Hemoglobin levels declined in both groups over time, but plasma hepcidin showed high specificity as a predictive marker for 28-day mortality. No significant differences in ICU stay and 28-day mortality rates were observed between groups (group I: 14.48 days ICU stay, 28% mortality; group II: 16.24 days ICU stay, 46% mortality).


Conclusion
Inflammatory anemia-related parameters, including plasma hepcidin, ferritin, interleukin-6, and sTfR, are significantly associated with 28-day mortality in septic patients. Managing these parameters may improve patient outcomes in the ICU, while blood transfusions do not impact ICU stay and 28-day mortality rates.