Worldwide audit of blood transfusion practice in critically ill patients
Worldwide audit of blood transfusion practice in critically ill patients
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DOI：
10.1186/s13054-018-2018-9
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发表时间：
2018-04-19
期刊：
影响因子：
15.1
通讯作者：
Sakr, Yasser
中科院分区：
文献类型：
--
作者：
Vincent, Jean-Louis;Jaschinski, Ulrich;Sakr, Yasser
背景：本研究的目的是描述国际上危重患者的输血实践，并评估输注红细胞(RBC)对这些患者预后的影响。方法：这是一项预先计划的分研究，涉及84个国家和地区的730个ICU，包括2012年5月8日至5月18日期间入院的所有成年患者，但不包括常规的术后监护。在纳入审计的10,069名患者中，9553名(平均年龄60+/-18岁，男性占60%)完成了与输血有关的数据；其中2511名(26.3%)接受过输血，不同地理区域之间有相当大的差异。输血当天平均最低血红蛋白为8.3+/-1.7g/dL，但中东为7.8+/-1.4g/dL，东欧为8.9+/-1.9g/dL。输血患者的住院死亡率高于未输血患者(30.0%比19.6%，p<；0.001)，并且随着输血单位数的增加而增加。在扩展的COX比例风险分析中，在整个队列中，输血后住院死亡的相对风险略低(风险比0.98，可信区间0.96-1.00，p=0.048)。结论：超过1/4的危重病患者在ICU期间输血，不同地区的输血实践有较大差异。在对混杂因素进行调整后，输注红细胞与院内死亡的相对风险略低相关，特别是在病情最严重的患者中，这突显了在做出输血决定时考虑疾病严重性的重要性。
Background: The aim was to describe transfusion practice in critically ill patients at an international level and evaluate the effects of red blood cell (RBC) transfusion on outcomes in these patients.Methods: This was a pre-planned sub-study of the Intensive Care Over Nations audit, which involved 730 ICUs in 84 countries and included all adult patients admitted between 8 May and 18 May 2012, except admissions for routine postoperative surveillance.Results: ICU and hospital outcomes were recorded. Among the 10,069 patients included in the audit, data related to transfusion had been completed for 9553 (mean age 60 +/- 18 years, 60% male); 2511 (26.3%) of these had received a transfusion, with considerable variation among geographic regions. The mean lowest hemoglobin on the day of transfusion was 8.3 +/- 1.7 g/dL, but varied from 7.8 +/- 1.4 g/dL in the Middle East to 8.9 +/- 1.9 g/dL in Eastern Europe. Hospital mortality rates were higher in transfused than in non-transfused patients (30.0% vs. 19.6%, p < 0.001) and increased with increasing numbers of transfused units. In an extended Cox proportional hazard analysis, the relative risk of in-hospital death was slightly lower after transfusion in the whole cohort (hazard ratio 0.98, confidence interval 0.96-1.00, p = 0.048). There was a stepwise decrease in the hazard ratio for mortality after transfusion with increasing admission severity scores.Conclusions: More than one fourth of critically ill patients are transfused during their ICU stay, with considerable variations in transfusion practice among geographic regions. After adjustment for confounders, RBC transfusions were associated with a slightly lower relative risk of in-hospital death, especially in the most severely ill patients, highlighting the importance of taking the severity of illness into account when making transfusion decisions.