Objective  To investigate the risk factors related to outcome of patients with severe massive hemorrhage in Intensive Care Unit (ICU).

  Methods  Clinical data of all patients receiving transfusion of red blood cell (RBC) of >20 U for severe massive hemorrhage, who were hospitalized between January 2013 and December 2015 in ICU of Peking Union Medical College Hospital, were analyzed retrospectively. Comparisons were conducted between patients who died (death group) and those survived (survival group). Risk factors related to outcome were analyzed with Logistic regression.

  Results  A total of 141 patients were identified, of whom 78 survived. In-hospital mortality was 44.7% (63/141). Among these patients with severe massive hemorrhage, there were 78 non-operation-related cases and 63 operation-related cases. The amount of RBC transfused in ICU (P=0.002), the proportion of non-operation-related cases (P=0.002), and the proportion of patients from emergency department (P=0.010) were all significantly higher in the death group than in the survival group, while the proportion of patients from surgical departments was lower in the death group than in the survival group (P=0.001). The baseline coagulation, renal, and liver function before RBC transfusion were significantly worse in the death group than in the survival group (all P < 0.05). Among the patients with non-operation-related severe massive hemorrhage, the death group had significantly higher proportion of severe massive hemorrhage due to infections (P=0.009), but significantly lower proportion of severe massive hemorrhage due to stress ulcer (P=0.048), baseline platelet level (P=0.003), and proportion of patients receiving surgical hemostasis (P=0.039). Among the patients with operation-related severe massive hemorrhage, the death group had higher volume of RBC transfusion in ICU (P=0.019), but higher proportions of patients with liver or renal function impairment before RBC transfusion (both P < 0.05). Logistic regression analysis showed that coagulation disorders (P=0.014, OR=3.594) and the presence of active massive hemorrhage after admission into ICU (P=0.025, OR=2.680) were risk factors for death in the patients with severe massive hemorrhage.

  Conclusion  For all the patients with severe massive hemorrhage, coagulation disorders and the presence of active massive hemorrhage in ICU may be risk factors for death.