Blood component ratios in children with non-traumatic life-threatening bleeding.
Blood component ratios in children with non-traumatic life-threatening bleeding.
复制标题
非创伤性危及生命的出血儿童的血液成分比率。
DOI：
10.1111/vox.13382
复制
发表时间：
2023
期刊：
影响因子：
2.7
通讯作者：
Spinella,PhilipC
中科院分区：
文献类型：
--
作者：
Marshall,Callie;Josephson,CassandraD;Leonard,JulieC;Wisniewski,StephenR;Leeper,ChristineM;Luther,JamesF;MATICInvestigatorsandBloodNet;Spinella,PhilipC
背景和目的在儿科创伤患者中，关于血液成分和死亡率的前瞻性数据有限，一些文献表明大量输血中血浆和血小板与红细胞（RBC）的高比率可降低死亡率;然而，大多数儿科大量输血发生在非创伤病因中，很少有研究评估这些儿童的血液制品比率。本研究的目的是评估是否高血制品比率或低赤字赋予非创伤性危及生命的bleeding.Materials和MethodsThis的儿童的生存效益是一个五年的，多中心的，前瞻性的，观察性的大量输血流行病学和结果在儿童研究中的危及生命的出血从美国，加拿大和意大利的医疗中心。主要干预措施为血浆：RBC和血小板：RBC（高比例≥1：2 ml/kg）以及血浆和血小板不足。主要结局为6 h、24 h和28 d的死亡率。多变量Logistic回归模型被用来确定独立的关联与mortality.ResultsA共222名儿童被纳入24个医疗中心：145名儿童（中位数[四分位数范围]年龄2.1年[0.3-11.8]）与手术出血和77（8.0年[1.2-14.7]）与医疗出血。在调整后的分析中，无论是血液制品的比率，也没有赤字与死亡率在6小时，24小时或28 day.ConclusionThis解决了缺乏前瞻性数据在儿童最佳的经验性大量输血策略，在非创伤性大出血，并发现没有降低死亡率与高血浆或血小板红细胞比率或较低的赤字支持探索性分析的死亡率。
Background and ObjectivesIn paediatric trauma patients, there are limited prospective data regarding blood components and mortality, with some literature suggesting decreased mortality with high ratios of plasma and platelets to red blood cells (RBCs) in massive transfusions; however, most paediatric massive transfusions occur for non‐traumatic aetiologies and few studies assess blood product ratios in these children. This study's objective was to evaluate whether high blood product ratios or low deficits conferred a survival benefit in children with non‐traumatic life‐threatening bleeding.Materials and MethodsThis is a secondary analysis of the five‐year, multicentre, prospective, observational massive transfusion epidemiology and outcomes in children study of children with life‐threatening bleeding from US, Canadian and Italian medical centres. Primary interventions were plasma:RBC and platelets:RBC (high ratio ≥1:2 ml/kg) and plasma and platelet deficits. The primary outcome was mortality at 6 h, 24 h and 28 days. Multivariate logistic regression models were used to determine independent associations with mortality.ResultsA total of 222 children were included from 24 medical centres: 145 children (median [interquartile range] age 2.1 years [0.3–11.8]) with operative bleeding and 77 (8.0 years [1.2–14.7]) with medical bleeding. In adjusted analyses, neither blood product ratios nor deficits were associated with mortality at 6 h, 24 h or 28 days.ConclusionThis paper addresses a lack of prospective data in children regarding optimal empiric massive transfusion strategies in non‐traumatic massive haemorrhage and in finding no decrease in mortality with high plasma or platelet to RBC ratios or lower deficits supports an exploratory analysis for mortality.