The Influence of Older Age on RBC Transfusion Decisions in ICU Patients

Objectives: – RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. Design: – This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. Setting: – ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. Patients: – Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65–75, 75–85, and > 85 yr). Interventions: – None. Measurements and Main Results: – A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53% were younger than 65 years, 26% were 65–75 years, 17% were 75–85 years, and 4% were older than 85 years. RBC transfusion rates ranged from 23% to 26% across all age groups (p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). “Age” and “improve general state” were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. Conclusions: – Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.