First ICU-day red blood cell transfusion burden and subsequent ICU delirium after cardiac surgery: a 24-h landmark study using MIMIC-IV
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Postoperative delirium is common after cardiac surgery and is associated with adverse outcomes. Red blood cell (RBC) transfusion is frequently administered during the early postoperative period in the setting of anemia, bleeding, and physiological instability, but its association with delirium developing thereafter remains uncertain. We conducted a retrospective cohort study using MIMIC-IV and a 24-h landmark design. Among 3,488 patients without documented delirium during the first 24 h, 916 received RBC transfusion. Subsequent ICU delirium occurred in 11.1% of transfused and 3.4% of nontransfused patients. RBC transfusion was associated with higher odds of subsequent delirium after adjustment (aOR 2.56, 95% CI 1.72–3.82), with attenuation in the extended model (aOR 1.74, 95% CI 1.13–2.68). The largest estimate occurred with > 700 mL (aOR 3.75, 95% CI 2.36–5.94). Among transfused patients with pre-transfusion hemoglobin available, each 350-mL increase in RBC volume was associated with higher odds of subsequent delirium after adjustment for pre-transfusion hemoglobin and baseline covariates (n = 839; adjusted OR 1.24, 95% CI 1.12–1.37). Competing-risk analysis yielded a similar association (sHR 1.74, 95% CI 1.15–2.63). Early RBC transfusion was associated with subsequent ICU delirium, although residual confounding by indication remains possible.
Source: Research Square
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7222996892