Journal Article Ahead of print
PubMed: 42616082 DOI: 10.1007/s00134-026-08582-4
Early red blood cell transfusion strategy in septic shock among patients with cancer: the TRANSPORT randomized controlled trial.
Intensive Care Med
Authors: Frédéric Pène, Clara Vigneron, Antoine Lafarge, Djamel Mokart, Yoann Zerbib, Emmanuel Canet, Toufik Kamel, Anne-Sophie Moreau, Cyril Cadoz, Maxens Decavèle, Armand Mekontso Dessap, Nathan Ebstein, Guillaume Lacave, Jonathan Chelly, Danielle Reuter, Laurent Argaud, Hafid Ait-Oufella, Naïke Bigé, Mélanie Levrard, Julien Charpentier, Magali Bisbal, Julien Maizel, Soraya Benguerfi, François Barbier, Côme Bureau, Noémie Bigot, Matthieu Resche-Rigon, Jérôme Lambert, Elie Azoulay
Affiliations
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive-Réanimation, Medical Intensive Care Unit, Hôpital Cochin, Université Paris Cité, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.
- Assistance Publique - Hôpitaux de Paris, Medical Intensive Care Unit, Hôpital Cochin, Université Paris Cité, Paris, France.
- Assistance Publique - Hôpitaux de Paris, Medical Intensive Care Unit, Hôpital Saint-Louis, Université Paris Cité, Paris, France.
- Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, Marseille, France.
- Medical Intensive Care Unit, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France.
- Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France.
- Medical Intensive Care Unit, Centre Hospitalier Universitaire d'Orléans, Orléans, France.
- Intensive Care Unit, Centre Hospitalier Universitaire de Lille, Hôpital Salengro, Lille, France.
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Régional Metz-Thionville Hôpital de Mercy, Metz, France.
- Assistance Publique-Hôpitaux de Paris, Medical Intensive Care Unit, (Department R3S), Hôpital de La Pitié-Salpêtrière, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Faculté de Santé, Medical Intensive Care Unit, Hôpitaux Universitaires Henri-Mondor, Université Paris Est-Créteil, INSERM U955, Institut Mondor, BioCrit, Université Paris Est-Créteil, GRCT CARMAS, Créteil, France.
- Assistance Publique - Hôpitaux de Paris, Intensive Care Unit, Hôpital Avicenne, Avicenne, Bobigny, France.
- Intensive Care Unit, Centre Hospitalier de Versailles, Site André Mignot, Le Chesnay, France.
- Intensive Care Unit, Groupe Hospitalier Sud Ile-de-France, Melun, France.
- Intensive Care Unit, Centre Hospitalier du Sud Francilien, Corbeil-Essonnes, France.
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
- Assistance Publique-Hôpitaux de Paris, Medical Intensive Care Unit, Hôpital Saint-Antoine, Sorbonne Université, Paris, France.
- Department of Intensive Care Medicine, Interdisciplinary Patient Pathway Division, Gustave Roussy, Villejuif, France.
- Centre Hospitalier Lyon-Sud, Intensive Care Unit, Hospices Civils de Lyon, Oullins-Pierre-Bénite, France.
- Centre Hospitalier Universitaire de Nantes, Medical Intensive Care Unit, Nantes Université, Movement-Interactions-Performance Research Unit (MIP, UR 4334), Nantes, France.
- Intensive Care Unit, Centre Hospitalier Universitaire de Lille, Hôpital Salengro, Université de Lille, ULR 2694 METRICS, Lille, France.
- Assistance Publique - Hôpitaux de Paris, Department of Biostatistics and Medical Information, Hôpital Saint-Louis, Paris, France.
- Assistance Publique - Hôpitaux de Paris, Department of Biostatistics and Medical Information, Hôpital Saint-Louis, Université Paris Cité, INSERM, Institut de Recherche Saint Louis, ECSTRRA, Paris, France.
- Assistance Publique - Hôpitaux de Paris, Medical Intensive Care Unit, Hôpital Saint-Louis, Université Paris Cité, INSERM, UMR1342, Institut de Recherche Saint-Louis, Paris, France.
Abstract
PURPOSE
Septic shock in cancer patients remains associated with a grim prognosis. With regard to the high prevalence of anemia, the optimal hemoglobin target to restore tissue oxygenation remains uncertain.
METHODS
This was a multicenter superiority randomized controlled trial carried out in 18 centers in France. Adult patients with hematological or solid malignancies presenting with septic shock with lactate level > 2.0 mmol/L and hemoglobin level < 9.0 g/dL were randomly assigned to liberal or restrictive red blood cell (RBC) transfusion directed by hemoglobin thresholds of 9.0 g/dL or 7.0 g/dL during the first 48 h of resuscitation. The primary endpoint was 12-h lactate reduction, defined as normalization ≤ 2.0 mmol/L or relative decrease by 30% from baseline. Key secondary endpoints included ICU-acquired infections, arterial and venous thrombotic events, and 28-day mortality.
RESULTS
The trial was designed to enroll 260 patients but was prematurely stopped for safety concerns. Finally, 187 patients were enrolled, distributed into 93 in the liberal arm and 94 in the restrictive arm. Twelve-hour lactate reduction was achieved in 52% and 50% of patients in the liberal and restrictive arms, respectively (odds ratio 1.07; 95% confidence interval 0.60 to 1.90; P = 0.82). Arterial or venous thrombotic events occurred more frequently in the liberal group (13% vs. 1%; P = 0.001), and 28-day mortality rates were 46% and 53% (P = 0.34), respectively.
CONCLUSIONS
In cancer patients with septic shock, this trial did not demonstrate superiority of liberal over restrictive transfusion strategy. The absence of mortality benefit and the uncertainty surrounding the observed imbalance in adverse events do not support the routine preference of either transfusion strategy over the other.
MeSH
Cells, Hemoglobins, Mortality, Erythrocytes, Blood, Erythrocyte Transfusion, Shock, Septic, Neoplasms, Critical Care, Blood Cells, Intensive Care Units