Impact of delayed initiation of erythropoietin in critically ill patients

Jeremiah J Duby¹ , Brian L Erstad² , Jacob Abarca³ , James M Camamo⁴ , Yvonne Huckleberry⁴ and Stuart N Bramblett⁴

¹Inpatient Pharmacy Department, Kaiser Permanente, 975 Sereno Dr., Vallejo, CA 94589, USA

²The University of Arizona College of Pharmacy, Department of Pharmacy Practice & Science- Pulido, 1295 N. Martin, Tucson, AZ 85721, USA

³WellPoint NextRx, 8401 Fallbrook Ave./MS CAAF01-0007, West Hills, CA 91304, USA

⁴University Medical Center, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA

author email corresponding author email

BMC Blood Disorders 2007, 7:1doi:10.1186/1471-2326-7-1


Published:	4 October 2007

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.