Age of transfused blood is an independent risk factor for postinjury multiple organ failure
Age of transfused blood is an independent risk factor for postinjury multiple organ failure
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DOI：
10.1016/s0002-9610(99)00239-1
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发表时间：
1999-12-01
影响因子：
3
通讯作者：
Silliman, CC
中科院分区：
文献类型：
--
作者：
Zallen, G;Offner, PJ;Silliman, CC
背景：输血已被反复证明是创伤后多器官功能衰竭（MOF）的独立危险因素。以前被认为是休克的替代品，最近已显示输注浓缩红细胞（PRBC）可导致中性粒细胞引发和肺内皮细胞活化。我们以前观察到炎症介质的产生与PRBC单位储存的长度有关。本研究的目的是确定是否输注PRBC的年龄是一个危险因素的发展伤后MOF.METHODS：使用我们的前瞻性数据库的创伤患者的风险发展多器官功能衰竭，我们确定了患者谁发展多器官功能衰竭（多器官功能衰竭+），并收到6至20个单位的PRBC在第一个12小时受伤后。还确定了一个类似的患者队列，ISS和输血要求匹配，未发生MOF（MOF-）。结果：63例患者中23例为多器官功能衰竭（MOF）+，两组患者ISS评分和输血量无显著性差异（P > 0. 05），两组患者的ISS评分和输血量无显著性差异（P > 0. 05）。然而，MOF+患者的年龄明显更大（46 +/- 4.7岁对33 +/- 2.3岁）。此外，MOF+患者的平均输血年龄更大（30.5 +/- 1.6天vs 24 +/- 0.5天）。同样，在MOF+患者中，超过14天和21天的平均单位数量也更多。多因素分析表明，平均血龄、大于14 d的单位数和大于21 d的单位数是发生多器官功能衰竭的独立危险因素。结论：6 h内输入PRBC的血龄是发生多器官功能衰竭的独立危险因素。此外，新鲜血液可能更适合于需要输血的创伤患者的初始复苏。Am J Surg，1999;178：570-572，（C）1999由Excerpta Medica，Inc.
BACKGROUND: Blood transfusion has repeatedly been demonstrated to be an independent risk factor for postinjury multiple organ failure (MOF). Previously believed to represent a surrogate for shock, packed red blood cell (PRBC) transfusion has recently been shown to result in neutrophil priming and pulmonary endothelial cell activation. We have previously observed that the generation of inflammatory mediators is related to the length of PRBC unit storage. The purpose of this study was to determine if age of transfused PRBC is a risk factor for the development of postinjury MOF.METHODS: Using our prospective database of trauma patients at risk for developing MOF, we identified patients who developed MOF (MOF+) and received 6 to 20 units of PRBCs in the first 12 hours following injury. A similar cohort of patients, matched for ISS and transfusion requirement, who did not develop MOF (MOF-) were also identified. The age of each unit of PRBC transfused in the first 6 hours was determined, Multiple logistic regression was performed to determine if age of transfused blood is an independent risk factor.RESULTS: Sixty-three patients were identified, 23 of whom were MOF+, There was no difference in ISS and transfusion requirement between MOF+ and MOF- groups. MOF+ patients, however, were significantly older (46 +/- 4.7 years versus 33 +/- 2.3 years). Moreover, mean age of transfused blood was greater in the MOF+ patients (30.5 +/- 1.6 days versus 24 +/- 0.5 days). Similarly, the mean number of units older than 14 and 21 days old were greater in the MOF+ patients. Multivariate analysis identified mean age of blood, number of units older than 14 days, and number of units older than 21 days as independent risk factors for MOF,CONCLUSION: The age of transfused PRBCs transfused in the first 6 hours is an independent risk factor for postinjury MOF, This suggests that current blood bank processing and storage technique should be reexamined. Moreover, fresh blood may be more appropriate for the initial resuscitation of trauma patients requiring transfusion. Am J Surg, 1999;178:570-572, (C) 1999 by Excerpta Medica, Inc.