Impact of delayed initiation of erythropoietin in critically ill patients

Persistent Link:
http://hdl.handle.net/10150/610341
Title:
Impact of delayed initiation of erythropoietin in critically ill patients
Author:
Duby, Jeremiah; Erstad, Brian; Abarca, Jacob; Camamo, James; Huckleberry, Yvonne; Bramblett, Stuart
Affiliation:
Inpatient Pharmacy Department, Kaiser Permanente, 975 Sereno Dr., Vallejo, CA 94589, USA; The University of Arizona College of Pharmacy, Department of Pharmacy Practice & Science- Pulido, 1295 N. Martin, Tucson, AZ 85721, USA; WellPoint NextRx, 8401 Fallbrook Ave./MS CAAF01-0007, West Hills, CA 91304, USA; University Medical Center, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA
Issue Date:
2007
Publisher:
BioMed Central
Citation:
BMC Blood Disorders 2007, 7:1 doi:10.1186/1471-2326-7-1
Journal:
BMC Blood Disorders
Rights:
© 2007 Duby et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)
Collection Information:
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.
Abstract:
BACKGROUND:The purpose of this study was to evaluate the impact of recombinant human erythropoietin (rHuEPO) use for anemia of critical illness at a practice site where delayed initiation is common.METHODS:Retrospective medical record review involving patients treated with rHuEPO for anemia of critical illness. Those patients given rHuEPO or diagnosed with end-stage renal disease (ESRD) prior to ICU admission were excluded. The primary endpoints were rHuEPO use and RBC transfusion patterns.RESULTS:Complete data were collected for consecutive admissions of 126 patients. Average age (SD) and APACHE II score were 56.5 (18.6) years and 25 (7.8), respectively. The median ICU (IQR) and hospital length of stay (LOS) were 24 (11.25, 39) and 29 (17, 44.75) days, respectively. Treatment with rHuEPO was started an average of 12.5 +/- 10.5 days after ICU admission and given for 3.8 +/- 3.8 doses. Eighty percent of patients were transfused with an average total of 5.42 +/- 5.08 units received. RBC exposure inversely correlated with a lower mean hemoglobin response to rHuEPO. ICU LOS (p < 0.0001), hemoglobin at 24 hours (p = 0.055), transfusion within 48 hours of admit (p < 0.0001), and postoperative status (p = 0.019) were the best predictors of transfusion requirements (r2 = 0.37).CONCLUSION:Delayed initiation of rHuEPO for anemia of critical illness resulted in comparable hemoglobin and transfusion benefits. Future studies are needed to establish clinical benefit and role in therapy. RBC exposure may blunt the erythropoietic effects of rHuEPO, potentially frustrating benefits to those of greatest apparent need.
EISSN:
1471-2326
DOI:
10.1186/1471-2326-7-1
Version:
Final published version
Additional Links:
http://www.biomedcentral.com/1471-2326/7/1

Full metadata record

DC FieldValue Language
dc.contributor.authorDuby, Jeremiahen
dc.contributor.authorErstad, Brianen
dc.contributor.authorAbarca, Jacoben
dc.contributor.authorCamamo, Jamesen
dc.contributor.authorHuckleberry, Yvonneen
dc.contributor.authorBramblett, Stuarten
dc.date.accessioned2016-05-20T09:04:40Z-
dc.date.available2016-05-20T09:04:40Z-
dc.date.issued2007en
dc.identifier.citationBMC Blood Disorders 2007, 7:1 doi:10.1186/1471-2326-7-1en
dc.identifier.doi10.1186/1471-2326-7-1en
dc.identifier.urihttp://hdl.handle.net/10150/610341-
dc.description.abstractBACKGROUND:The purpose of this study was to evaluate the impact of recombinant human erythropoietin (rHuEPO) use for anemia of critical illness at a practice site where delayed initiation is common.METHODS:Retrospective medical record review involving patients treated with rHuEPO for anemia of critical illness. Those patients given rHuEPO or diagnosed with end-stage renal disease (ESRD) prior to ICU admission were excluded. The primary endpoints were rHuEPO use and RBC transfusion patterns.RESULTS:Complete data were collected for consecutive admissions of 126 patients. Average age (SD) and APACHE II score were 56.5 (18.6) years and 25 (7.8), respectively. The median ICU (IQR) and hospital length of stay (LOS) were 24 (11.25, 39) and 29 (17, 44.75) days, respectively. Treatment with rHuEPO was started an average of 12.5 +/- 10.5 days after ICU admission and given for 3.8 +/- 3.8 doses. Eighty percent of patients were transfused with an average total of 5.42 +/- 5.08 units received. RBC exposure inversely correlated with a lower mean hemoglobin response to rHuEPO. ICU LOS (p < 0.0001), hemoglobin at 24 hours (p = 0.055), transfusion within 48 hours of admit (p < 0.0001), and postoperative status (p = 0.019) were the best predictors of transfusion requirements (r2 = 0.37).CONCLUSION:Delayed initiation of rHuEPO for anemia of critical illness resulted in comparable hemoglobin and transfusion benefits. Future studies are needed to establish clinical benefit and role in therapy. RBC exposure may blunt the erythropoietic effects of rHuEPO, potentially frustrating benefits to those of greatest apparent need.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urlhttp://www.biomedcentral.com/1471-2326/7/1en
dc.rights© 2007 Duby et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)en
dc.titleImpact of delayed initiation of erythropoietin in critically ill patientsen
dc.typeArticleen
dc.identifier.eissn1471-2326en
dc.contributor.departmentInpatient Pharmacy Department, Kaiser Permanente, 975 Sereno Dr., Vallejo, CA 94589, USAen
dc.contributor.departmentThe University of Arizona College of Pharmacy, Department of Pharmacy Practice & Science- Pulido, 1295 N. Martin, Tucson, AZ 85721, USAen
dc.contributor.departmentWellPoint NextRx, 8401 Fallbrook Ave./MS CAAF01-0007, West Hills, CA 91304, USAen
dc.contributor.departmentUniversity Medical Center, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USAen
dc.identifier.journalBMC Blood Disordersen
dc.description.collectioninformationThis item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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