Bleeding, Transfusion, and Mortality on Extracorporeal Life Support: ECLS Working Group on Thrombosis and Hemostasis
Bleeding, Transfusion, and Mortality on Extracorporeal Life Support: ECLS Working Group on Thrombosis and Hemostasis
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DOI：
10.1016/j.athoracsur.2015.07.046
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发表时间：
2016-02-01
影响因子：
4.6
通讯作者：
Pham, Si
中科院分区：
文献类型：
--
作者：
Mazzeffi, Michael;Greenwood, John;Pham, Si
背景成人体外生命支持期间可能经常发生出血;然而，没有详细研究出血事件、红细胞输注及其对死亡率的影响。本研究的目的是描述成人体外生命支持期间出血和红细胞输注的发生率，并检查其对死亡率的影响。我们对大约3年的成人体外生命支持患者进行了回顾性分析。记录出血事件和输血的发生率。进行未校正和校正的多变量logistic回归分析，以估计出血患者和每输注一个红细胞单位的住院死亡率。比较流血的和未出血患者的90天生存率。132例患者中有74例（56.1%）发生严重出血事件，出血率为10起事件/100天。流血的患者院内死亡率的粗比值比为2.22（95%置信区间[CI]：1.00 - 4.94，p = 0.05）;每单位红细胞输注的粗比值比为1.03（95% CI：1.01 - 1.04，p = 0.005）。出血和红细胞输注的校正比值比为0.90（95% CI：0.37 - 2.19，p = 0.82）和1.03（95% CI：1.00 - 1.06，p = 0.04）。与未出血患者相比，流血的患者的90天生存率有下降的趋势（46.7% vs 64.9%，p = 0.08）。结论.在成人体外生命支持期间，出血和红细胞输注频繁发生，但在控制混杂变量后，只有红细胞输注量与院内死亡率相关。(C)2016胸外科医师协会
Background. Bleeding may occur frequently during adult extracorporeal life support; however, there are no detailed investigations of bleeding events, red blood cell transfusion, and their impact on mortality. The purpose of our study was to characterize the incidence of bleeding and red blood cell transfusion during adult extracorporeal life support and examine the impact on mortality.Methods. We performed a retrospective analysis of adult extracorporeal life support patients over approximately a 3-year period. The incidence of bleeding events and transfusions were recorded. Unadjusted and adjusted multivariate logistic regression analyses were performed to estimate the odds of inhospital mortality among patients with bleeding and for each red blood cell unit transfused. Ninety-day survival was compared between patients who bled and those who did not.Results. Serious bleeding events occurred in 74 of 132 patients (56.1%), and the rate of bleeding was 10 events per 100 days. The crude odds ratio for inhospital mortality in patients who bled was 2.22 (95% confidence interval [CI]: 1.00 to 4.94, p = 0.05); and for each unit of red blood cells transfused, it was 1.03 (95% CI: 1.01 to 1.04, p = 0.005). The adjusted odds ratios for bleeding and red blood cell transfusions were 0.90 (95% CI: 0.37 to 2.19, p = 0.82) and 1.03 (95% CI: 1.00 to 1.06, p = 0.04). There was a trend toward decreased 90- day survival among patients who bled compared with patients who did not (46.7% versus 64.9%, p = 0.08). Conclusions. Bleeding and red blood cell transfusion occur frequently during adult extracorporeal life support, but only the amount of red blood cell transfusion is associated with inhospital mortality after controlling for confounding variables. (C) 2016 by The Society of Thoracic Surgeons