Faculty Collaboration Database

A multicenter, randomized clinical trial of IV iron supplementation for anemia of traumatic critical illness*. Crit Care Med 2014 Sep;42(9):2048-57

Date

05/07/2014

Pubmed ID

24797376

DOI

10.1097/CCM.0000000000000408

Scopus ID

2-s2.0-84906789925 (requires institutional sign-in at Scopus site)   74 Citations

Abstract

OBJECTIVE: To evaluate the efficacy of IV iron supplementation of anemic, critically ill trauma patients.

DESIGN: Multicenter, randomized, single-blind, placebo-controlled trial.

SETTING: Four trauma ICUs.

PATIENTS: Anemic (hemoglobin < 12 g/dL) trauma patients enrolled within 72 hours of ICU admission and with an expected ICU length of stay of more than or equal to 5 days.

INTERVENTIONS: Randomization to iron sucrose 100 mg IV or placebo thrice weekly for up to 2 weeks.

MEASUREMENTS AND MAIN RESULTS: A total of 150 patients were enrolled. Baseline iron markers were consistent with functional iron deficiency: 134 patients (89.3%) were hypoferremic, 51 (34.0%) were hyperferritinemic, and 64 (42.7%) demonstrated iron-deficient erythropoiesis as evidenced by an elevated erythrocyte zinc protoporphyrin concentration. The median baseline transferrin saturation was 8% (range, 2-58%). In the subgroup of patients who received all six doses of study drug (n = 57), the serum ferritin concentration increased significantly for the iron as compared with placebo group on both day 7 (808.0 ng/mL vs 457.0 ng/mL, respectively, p < 0.01) and day 14 (1,046.0 ng/mL vs 551.5 ng/mL, respectively, p < 0.01). There was no significant difference between groups in transferrin saturation, erythrocyte zinc protoporphyrin concentration, hemoglobin concentration, or packed RBC transfusion requirement. There was no significant difference between groups in the risk of infection, length of stay, or mortality.

CONCLUSIONS: Iron supplementation increased the serum ferritin concentration significantly, but it had no discernible effect on transferrin saturation, iron-deficient erythropoiesis, hemoglobin concentration, or packed RBC transfusion requirement. Based on these data, routine IV iron supplementation of anemic, critically ill trauma patients cannot be recommended (NCT 01180894).

Author List

Pieracci FM, Stovall RT, Jaouen B, Rodil M, Cappa A, Burlew CC, Holena DN, Maier R, Berry S, Jurkovich J, Moore EE

Author

Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

APACHE
Administration, Intravenous
Adolescent
Adult
Aged
Aged, 80 and over
Anemia
Critical Illness
Erythrocyte Transfusion
Erythropoiesis
Female
Ferric Compounds
Glucaric Acid
Hematinics
Humans
Intensive Care Units
Male
Middle Aged
Protoporphyrins
Single-Blind Method
Transferrin
Trauma Centers
Young Adult