TRICOP
Trial question
What is the role of liberal transfusion strategy in critically ill cancer patients with septic shock?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
49.0% female
51.0% male
N = 300
300 patients (146 female, 154 male)
Inclusion criteria: adult cancer patients with septic shock in the first 6 hours of ICU admission
Key exclusion criteria: age < 18 years; inability to receive a transfusion of blood components; high expected mortality or transfusion rate
Interventions
N=149 liberal strategy (hemoglobin threshold < 9 g/dL of RBC transfusion)
N=151 restrictive strategy (hemoglobin threshold < 7 g/dL of RBC transfusion)
Primary outcome
Death at day 28
45
55.6
55.6 %
41.7 %
27.8 %
13.9 %
0.0 %
Liberal
strategy
Restrictive
strategy
No significant
difference ↔
No significant difference in death at day 28 (45% vs. 55.6%; HR 0.74, 95% CI 0.53 to 1.04)
Secondary outcomes
No significant difference in need for mechanical ventilation (30.9% vs. 38.7%; OR 0.71, 95% CI 0.44 to 1.15)
No significant difference in ICU readmission (4% vs. 5.3%; OR 0.75, 95% CI 0.25 to 2.22)
No significant difference in RRT (8.7% vs. 12%; OR 0.7, 95% CI 0.33 to 1.49)
Safety outcomes
No significant differences in acute myocardial infarction, cerebral ischemia, and limb ischemia.
Significant differences in death at 90 days (59.1% vs. 70.2%), overall RBC transfusion (1 unit vs. 0 unit).
Conclusion
In adult cancer patients with septic shock in the first 6 hours of ICU admission, liberal strategy was not superior to restrictive strategy with respect to death at day 28.
Reference
Fabricio S Bergamin, Juliano P Almeida, Giovanni Landoni et al. Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial. Crit Care Med. 2017 May;45(5):766-773.
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