{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:42:23Z","timestamp":1787701343963,"version":"build-2784847793"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Patients with chronic kidney disease (CKD) often have impaired immune function, making them more prone to infections that can lead to sepsis. The coexistence of these conditions can result in decreased hemoglobin levels and is associated with a higher mortality rate. To investigate whether the transfusion of red blood cells (RBCs) improves the prognosis of septic patients with concomitant CKD and to explore the indications for red blood cell transfusion. This retrospective cohort study utilizes data from the MIMIC-IV (v2.0) database. The study enrolled 6,604 patients with sepsis and concomitant CKD admitted to the Intensive Care Unit (ICU). Propensity score matching (PSM) was applied to adjust for confounding factors. Multivariate Cox regression analysis revealed an association between RBC transfusion and a decreased risk of 28-day mortality (HR: 0.61, 95% CI: 0.54\u20130.70, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Following a meticulous 1:1 propensity score matching analysis between the two cohorts, the matched population revealed a notable decrease in 28-day mortality within the RBC transfusion group (HR: 0.60, 95% CI: 0.51\u20130.71; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Additionally, we observed that a SOFA score\u2009\u2265\u20095, a Base Excess (BE) value\u2009&lt;\u20093, and an estimated Glomerular Filtration Rate (eGFR)\u2009&lt;\u200930 may be considered when evaluating the potential need for RBC transfusion. This study demonstrated an association between RBC transfusion and decreased 28-day mortality in patients with sepsis accompanied by CKD. The patient\u2019s BE value, SOFA score, and eGFR are crucial factors influencing the treatment outcome and should be considered when deciding on RBC transfusion.<\/jats:p>","DOI":"10.1038\/s41598-024-75643-3","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T17:02:09Z","timestamp":1728579729000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between red blood cells transfusion and 28-day mortality rate in septic patients with concomitant chronic kidney disease"],"prefix":"10.1038","volume":"14","author":[{"given":"Lei","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honglei","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenwei","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haibin","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renjun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxing","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,10]]},"reference":[{"key":"75643_CR1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","volume":"315","author":"M Singer","year":"2016","unstructured":"Singer, M. et al. The Third International Consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA-J AM. MED. ASSOC. 315, 801 (2016).","journal-title":"JAMA-J AM. MED. ASSOC."},{"key":"75643_CR2","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1007\/s12325-020-01568-8","volume":"38","author":"M Murton","year":"2021","unstructured":"Murton, M. et al. Burden of chronic kidney disease by KDIGO Categories of Glomerular Filtration Rate and Albuminuria: a systematic review. ADV. THER. 38, 180 (2021).","journal-title":"ADV. THER."},{"key":"75643_CR3","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.ekir.2019.12.003","volume":"5","author":"VA Luyckx","year":"2020","unstructured":"Luyckx, V. A., Cherney, D. & Bello, A. K. Preventing CKD in developed countries. KIDNEY INT. REP. 5, 263 (2020).","journal-title":"KIDNEY INT. REP."},{"key":"75643_CR4","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1186\/s12872-022-02763-x","volume":"22","author":"F Huang","year":"2022","unstructured":"Huang, F. et al. The association between blood albumin level and cardiovascular complications and mortality risk in ICU patients with CKD. BMC CARDIOVASC. DISOR. 22, 322 (2022).","journal-title":"BMC CARDIOVASC. DISOR"},{"key":"75643_CR5","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1159\/000330673","volume":"34","author":"HE Wang","year":"2011","unstructured":"Wang, H. E., Gamboa, C., Warnock, D. G. & Muntner, P. Chronic kidney disease and risk of death from infection. AM. J. NEPHROL. 34, 330 (2011).","journal-title":"AM. J. NEPHROL."},{"key":"75643_CR6","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.2215\/CJN.00250117","volume":"12","author":"H Xu","year":"2017","unstructured":"Xu, H. et al. eGFR and the risk of community-acquired infections. CLIN. J. AM. SOC. NEPHRO. 12, 1399 (2017).","journal-title":"CLIN. J. AM. SOC. NEPHRO"},{"key":"75643_CR7","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1053\/j.ajkd.2014.11.027","volume":"66","author":"HI McDonald","year":"2015","unstructured":"McDonald, H. I., Thomas, S. L., Millett, E. R. & Nitsch, D. CKD and the risk of acute, community-acquired infections among older people with diabetes mellitus: a retrospective cohort study using electronic health records. AM. J. KIDNEY DIS. 66, 60 (2015).","journal-title":"AM. J. KIDNEY DIS."},{"key":"75643_CR8","doi-asserted-by":"publisher","first-page":"809292","DOI":"10.3389\/fmed.2022.809292","volume":"9","author":"SM Ou","year":"2022","unstructured":"Ou, S. M. et al. Sepsis and the risks of long-term renal adverse outcomes in patients with chronic kidney disease. FRONT. MED-LAUSANNE. 9, 809292 (2022).","journal-title":"FRONT. MED-LAUSANNE"},{"key":"75643_CR9","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1164\/rccm.201110-1915CI","volume":"185","author":"SJ Hayden","year":"2012","unstructured":"Hayden, S. J., Albert, T. J., Watkins, T. R. & Swenson, E. R. Anemia in critical illness: insights into etiology, consequences, and management. AM. J. RESP. CRIT. CARE. 185, 1049 (2012).","journal-title":"AM. J. RESP. CRIT. CARE"},{"key":"75643_CR10","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1681\/ASN.2011111078","volume":"23","author":"JL Babitt","year":"2012","unstructured":"Babitt, J. L. & Lin, H. Y. Mechanisms of anemia in CKD. J. AM. SOC. NEPHROL. 23, 1631 (2012).","journal-title":"J. AM. SOC. NEPHROL."},{"key":"75643_CR11","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s40635-019-0261-2","volume":"7","author":"M Boshuizen","year":"2019","unstructured":"Boshuizen, M. et al. Development of a model for anemia of inflammation that is relevant to critical care. INTENS CARE MED. EXP. 7, 47 (2019).","journal-title":"INTENS CARE MED. EXP."},{"key":"75643_CR12","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s13613-019-0542-7","volume":"9","author":"Y Jiang","year":"2019","unstructured":"Jiang, Y. et al. Inflammatory anemia-associated parameters are related to 28-day mortality in patients with sepsis admitted to the ICU: a preliminary observational study. ANN. INTENSIVE CARE. 9, 67 (2019).","journal-title":"ANN. INTENSIVE CARE"},{"key":"75643_CR13","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1164\/rccm.200504-561OC","volume":"174","author":"YE Claessens","year":"2006","unstructured":"Claessens, Y. E. et al. Erythropoiesis abnormalities contribute to early-onset anemia in patients with septic shock. AM. J. RESP. CRIT. CARE. 174, 51 (2006).","journal-title":"AM. J. RESP. CRIT. CARE"},{"key":"75643_CR14","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s40620-019-00652-9","volume":"33","author":"G Toft","year":"2020","unstructured":"Toft, G. et al. Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study. J. NEPHROL. 33, 147 (2020).","journal-title":"J. NEPHROL."},{"key":"75643_CR15","doi-asserted-by":"publisher","first-page":"3403","DOI":"10.1681\/ASN.2005030226","volume":"16","author":"PT Vlagopoulos","year":"2005","unstructured":"Vlagopoulos, P. T. et al. Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J. AM. SOC. NEPHROL. 16, 3403 (2005).","journal-title":"J. AM. SOC. NEPHROL."},{"key":"75643_CR16","doi-asserted-by":"publisher","first-page":"141","DOI":"10.4266\/acc.2019.00465","volume":"34","author":"SM Jung","year":"2019","unstructured":"Jung, S. M., Kim, Y. J., Ryoo, S. M. & Kim, W. Y. Relationship between low hemoglobin levels and mortality in patients with septic shock. ACUTE CRIT. CARE. 34, 141 (2019).","journal-title":"ACUTE CRIT. CARE"},{"key":"75643_CR17","doi-asserted-by":"publisher","first-page":"992","DOI":"10.7326\/0003-4819-111-12-992","volume":"111","author":"JW Eschbach","year":"1989","unstructured":"Eschbach, J. W. et al. Recombinant human erythropoietin in anemic patients with end-stage renal disease. Results of a phase III multicenter clinical trial. ANN. INTERN. MED. 111, 992 (1989).","journal-title":"ANN. INTERN. MED."},{"key":"75643_CR18","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1016\/S0272-6386(97)90339-5","volume":"29","author":"P Barany","year":"1997","unstructured":"Barany, P., Divino, F. J. & Bergstrom, J. High C-reactive protein is a strong predictor of resistance to erythropoietin in hemodialysis patients. AM. J. KIDNEY DIS. 29, 565 (1997).","journal-title":"AM. J. KIDNEY DIS."},{"key":"75643_CR19","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/00002480-200101000-00017","volume":"47","author":"M Tonelli","year":"2001","unstructured":"Tonelli, M., Blake, P. G. & Muirhead, N. Predictors of erythropoietin responsiveness in chronic hemodialysis patients. ASAIO J. 47, 82 (2001).","journal-title":"ASAIO J."},{"key":"75643_CR20","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1056\/NEJMra1612789","volume":"377","author":"JL Carson","year":"2017","unstructured":"Carson, J. L., Triulzi, D. J. & Ness, P. M. Indications for and adverse effects of Red-Cell Transfusion. NEW. ENGL. J. MED. 377, 1261 (2017).","journal-title":"NEW. ENGL. J. MED."},{"key":"75643_CR21","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1056\/NEJM199902113400601","volume":"340","author":"PC Hebert","year":"1999","unstructured":"Hebert, P. C. et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials Group. NEW. ENGL. J. MED. 340, 409 (1999).","journal-title":"NEW. ENGL. J. MED."},{"key":"75643_CR22","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1056\/NEJMoa1406617","volume":"371","author":"LB Holst","year":"2014","unstructured":"Holst, L. B. et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. NEW. ENGL. J. MED. 371, 1381 (2014).","journal-title":"NEW. ENGL. J. MED."},{"key":"75643_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41597-022-01899-x","volume":"10","author":"A Johnson","year":"2023","unstructured":"Johnson, A. et al. MIMIC-IV, a freely accessible electronic health record dataset. SCI. DATA. 10, 1 (2023).","journal-title":"SCI. DATA"},{"key":"75643_CR24","doi-asserted-by":"publisher","first-page":"825","DOI":"10.7326\/0003-4819-158-11-201306040-00007","volume":"158","author":"PE Stevens","year":"2013","unstructured":"Stevens, P. E. & Levin, A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. ANN. INTERN. MED. 158, 825 (2013).","journal-title":"ANN. INTERN. MED."},{"key":"75643_CR25","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","volume":"28","author":"PC Austin","year":"2009","unstructured":"Austin, P. C. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. STAT. MED. 28, 3083 (2009).","journal-title":"STAT. MED."},{"key":"75643_CR26","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.1093\/aje\/kwy049","volume":"187","author":"SV Wang","year":"2018","unstructured":"Wang, S. V. et al. Relative performance of propensity score matching strategies for subgroup analyses. AM. J. EPIDEMIOL. 187, 1799 (2018).","journal-title":"AM. J. EPIDEMIOL."},{"key":"75643_CR27","doi-asserted-by":"publisher","first-page":"e0159335","DOI":"10.1371\/journal.pone.0159335","volume":"11","author":"YH Khan","year":"2016","unstructured":"Khan, Y. H., Sarriff, A., Adnan, A. S., Khan, A. H. & Mallhi, T. H. Chronic kidney Disease, Fluid overload and diuretics: a complicated triangle. PLOS ONE. 11, e0159335 (2016).","journal-title":"PLOS ONE"},{"key":"75643_CR28","doi-asserted-by":"crossref","unstructured":"Besen, B. A. & Taniguchi, L. U. Negative Fluid Balance in Sepsis: When and How? SHOCK 47 35 (2017).","DOI":"10.1097\/SHK.0000000000000701"},{"key":"75643_CR29","doi-asserted-by":"publisher","first-page":"R74","DOI":"10.1186\/cc6916","volume":"12","author":"D Payen","year":"2008","unstructured":"Payen, D. et al. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. CRIT. CARE. 12, R74 (2008).","journal-title":"CRIT. CARE"},{"key":"75643_CR30","doi-asserted-by":"crossref","unstructured":"Douglas, I. S. et al. Fluid Response Evaluation in Sepsis Hypotension and Shock: A Randomized Clinical Trial. CHEST 158 1431 (2020).","DOI":"10.1016\/j.chest.2020.04.025"},{"key":"75643_CR31","doi-asserted-by":"publisher","first-page":"R197","DOI":"10.1186\/cc11682","volume":"16","author":"ST Vaara","year":"2012","unstructured":"Vaara, S. T. et al. Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study. CRIT. CARE. 16, R197 (2012).","journal-title":"CRIT. CARE"},{"key":"75643_CR32","first-page":"786","volume":"11","author":"ER Argaiz","year":"2022","unstructured":"Argaiz, E. R., Rola, P., Haycock, K. H. & Verbrugge, F. H. Fluid management in acute kidney injury: from evaluating fluid responsiveness towards assessment of fluid tolerance. EUR. HEART J-ACUTE CA. 11, 786 (2022).","journal-title":"EUR. HEART J-ACUTE CA"},{"key":"75643_CR33","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1007\/s00134-016-4437-x","volume":"42","author":"SL Rygard","year":"2016","unstructured":"Rygard, S. L. et al. Long-term outcomes in patients with septic shock transfused at a lower versus a higher haemoglobin threshold: the TRISS randomised, multicentre clinical trial. INTENS CARE MED. 42, 1685 (2016).","journal-title":"INTENS CARE MED."},{"key":"75643_CR34","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/S0140-6736(02)07500-1","volume":"359","author":"DA Grimes","year":"2002","unstructured":"Grimes, D. A. & Schulz, K. F. Cohort studies: marching towards outcomes. LANCET. 359, 341 (2002).","journal-title":"LANCET"},{"key":"75643_CR35","doi-asserted-by":"publisher","first-page":"2908","DOI":"10.1093\/ndt\/gft362","volume":"28","author":"JM Yabu","year":"2013","unstructured":"Yabu, J. M. et al. Sensitization from transfusion in patients awaiting primary kidney transplant. NEPHROL. DIAL TRANSPL. 28, 2908 (2013).","journal-title":"NEPHROL. DIAL TRANSPL."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-75643-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-75643-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-75643-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T17:06:50Z","timestamp":1728580010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-75643-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,10]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["75643"],"URL":"https:\/\/doi.org\/10.1038\/s41598-024-75643-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,10]]},"assertion":[{"value":"18 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"23769"}}