The effect of liberal and restrictive transfusion strategies on survival in oncology patients with sepsis in the intensive care unit

Background: Red blood cell (RBC) transfusion is a commonly utilized supportive therapy in intensive care units (ICUs). However, the optimal transfusion strategy in oncologic patients with sepsis remains controversial. This study aimed to compare the clinical outcomes of liberal versus restrictive transfusion strategies in oncologic patients with sepsis admitted to the ICU. Methods: This retrospective descriptive study included oncologic patients diagnosed with sepsis who were admitted to the ICU and received RBC transfusion between 2019 and 2024. Patients were stratified into two groups based on transfusion thresholds: liberal (hemoglobin, (Hb) ≥ 9 g/dL) and restrictive (Hb < 9 g/dL). Demographic characteristics, clinical scores (Acute physiology and chronic health evaluation (APACHE II), sepsis-related organ failure assessment (SOFA), charlson comorbidity index (CCI)), primary oncologic diagnoses, laboratory parameters, organ dysfunction, infection characteristics, and mortality outcomes were compared. Statistical analyses included descriptive statistics and two-model logistic regression. Results: A total of 658 patients were included. The restrictive transfusion group had significantly higher APACHE II and SOFA scores. There was a significant difference in primary cancer types between groups: lung cancer was more common in the liberal group, whereas gastrointestinal cancers predominated in the restrictive group. While overall organ dysfunction rates were similar, renal injury was more frequent in the restrictive group. No significant differences were found between groups regarding duration of mechanical ventilation, need for inotropes, or renal replacement therapy. Although no difference was observed in 28-day mortality between the groups, 90-day mortality was higher in the restrictive group; however, this difference lost statistical significance after adjustment for clinical scores. Conclusion: In ICU patients with sepsis and malignancy, liberal and restrictive transfusion strategies demonstrated some differences in clinical parameters but did not show a clear superiority regarding overall mortality or the need for organ support. These findings emphasize the importance of individualizing transfusion strategies based on patient-specific characteristics. Given the heterogeneity and conflicting results in the literature, further randomized controlled trials involving diverse patient subgroups are warranted. Keywords: Red blood cell transfusion, sepsis, oncology patients, intensive care, restrictive transfusion, liberal transfusion, mortality.