(P-TS-37) Effect of Blood Donor Sex on Hospital-onset Sepsis in Intensive Care Unit Patients Receiving Red Cell Transfusions

Background/Case Studies: Sepsis is life-threatening immune dysregulation to infection in critically ill patients, where 30% receive a red cell concentrate (RCC) transfusion. Conflicting results suggest that blood donor sex may affect the incidence of infection and mortality in transfused patients. However, there is a lack of observational studies on the effect of donor sex on hospital-onset (HO)- sepsis in critically ill patients. This retrospective study aimed to investigate the impact of donor sex on HO-sepsis in critically ill patients receiving transfusions.

Study

Design/Methods: A data-linked analysis was performed using blood donor and recipient data from the blood supplier's donor database and a comprehensive clinical database in academic hospitals. Transfusion data from 2010 to 2020 included 10,307 adult patients who received their first allogeneic RCC transfusion in the intensive care unit. Among them, 3410 underwent single or multiple transfusions exclusively from male or female blood donors. HO-sepsis was determined based on diagnostic data coded using the International Classification of Disease and Related Health Problems 10th Revision (ICD-10) codes without needing a microbiology test within the first 48 hours of admission. Univariate and multivariate analyses were conducted for HO-sepsis considering a four-level exposure variable related to donor-recipient sex combinations (female to female, male to female, female to male, male to male), and adjusting for covariates, such as recipient age, diagnosis, blood type,pre-transfusion hemoglobin, the number of RCC units transfused, other pre-RCC transfusion, and donor pre-donation hemoglobin.

Results/Findings: There was no significant difference in the HO-sepsis rate among the four groups (female to female [4.3%, n = 581]; male to male [4.2%, n = 903]; male to female [2.6%, n = 737]; and female to male [3.1%, n = 1189]; p > 0.05). Female recipients displayed a higher susceptibility to HO-sepsis compared to their male counterparts [OR 1.52, 95% CI, 1.04 - 2.21; p < 0.05].In the multivariate analysis, the number of RCC units transfused (p < 0.05) and recipient age (p < 0.05), were significant contributors to HO-sepsis.

Conclusions: Donor sex was not associated with HO-sepsis in critically ill patients receiving RCC transfusions. Key factors for developing HO-sepsis were recipient characteristics and the number of RCC units transfused. Further exploration of the impact of sex mis-matched transfusion on recipient outcomes is warranted.