Massive Transfusion in Cardiac Surgery: The Impact of Blood Component Ratios on Clinical Outcomes and Survival
Massive Transfusion in Cardiac Surgery: The Impact of Blood Component Ratios on Clinical Outcomes and Survival
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DOI：
10.1213/ane.0000000000001926
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发表时间：
2017-06-01
影响因子：
5.7
通讯作者：
Sloan, Steven R.
中科院分区：
文献类型：
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作者：
Delaney, Meghan;Stark, Paul C.;Sloan, Steven R.
背景：在医学发达国家，心脏手术是最常见的大量输血。损伤后大量输血的研究表明，血浆和血小板（PLT）与红细胞（RBC）的比例影响死亡率。红细胞储存时间研究（RECESS）是一项大型随机试验，旨在研究红细胞储存时间对接受复杂心脏手术患者的影响，我们对该研究的数据进行了回顾性分析，以研究大量输血患者使用的血液成分比例与随后的临床结局之间的相关性。对于血浆，高比率定义为>= 1血浆单位：1 RBC单位。对于PLT输血，高比率定义为>= 0.2 PLT剂量：1 RBC单位; PLT剂量定义为1个单采PLT或5个全血PLT当量。分析的临床结局是死亡率和多器官功能障碍评分（Delta MODS）的变化，将术前评分与最高综合评分进行比较，直至死亡、出院或第7天。比较了高比率和低比率输血患者的结局。线性和考克斯回归被用来探讨预测因素和连续的结果和时间事件outcome.RESULTS：共324例受试者符合大量输血的定义之间的关系。在接受高血浆：红细胞比率的患者中，平均（SE）7天和28天Delta MODS分别比接受较低比率的患者低1.24（0.45）和1.26（0.56）分（P =.007和P =.024）。在接受高PLT：RBC比率的患者中，平均（SE）7天和28天Delta MODS分别低1.55（0.53）和1.49（0.65）分（P = 0.004和P = 0.022）。接受低比例血浆：红细胞输注的受试者与接受高比例血浆：红细胞输注的受试者相比，7天死亡率较高（分别为7.2%和1.7%，P = 0.0318），在28天仍有显著性差异（P = 0.035）。PLT比值：红细胞与死亡率的差异无关。结论：这项分析发现，在复杂的心脏手术患者接受大量输血，有一个使用的血液制品和临床结果的组成之间的关联。具体来说，接受高比例输血（血浆：红细胞和血小板：红细胞）的患者器官功能障碍较少，接受高比例血浆：红细胞输血的患者死亡率较低。
BACKGROUND: Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion after injury suggest that the ratios of administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from the Red Cell Storage Duration Study (RECESS), a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac surgery, were analyzed retrospectively to investigate the association between blood component ratios used in massively transfused patients and subsequent clinical outcomes.METHODS: Massive transfusion was defined as those who had >= 6 RBC units or >= 8 total blood components. For plasma, high ratio was defined as >= 1 plasma unit: 1 RBC unit. For PLT transfusion, high ratio was defined as >= 0.2 PLT doses: 1 RBC unit; PLT dose was defined as 1 apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score (Delta MODS) comparing the preoperative score with the highest composite score through the earliest of death, discharge, or day 7. Outcomes were compared between patients transfused with high and low ratios. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes and time to event outcomes.RESULTS: A total of 324 subjects met the definition of massive transfusion. In those receiving high plasma: RBC ratio, the mean (SE) 7-and 28-day Delta MODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P =.007 and P =.024), respectively, than in patients receiving lower ratios. In patients receiving high PLT: RBC ratio, the mean (SE) 7-and 28-day Delta MODS were 1.55 (0.53) and 1.49 (0.65) points lower (P =.004 and P =.022), respectively. Subjects who received low-ratio plasma: RBC transfusion had excess 7-day mortality compared with those who received high ratio (7.2% vs 1.7%, respectively, P =.0318), which remained significant at 28 days (P =.035). The ratio of PLT: RBCs was not associated with differences in mortality.CONCLUSIONS: This analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of blood products used and clinical outcomes. Specifically, there was less organ dysfunction in those who received high-ratio transfusions (plasma: RBCs and PLT: RBCs), and lower mortality in those who received high-ratio plasma: RBC transfusions.