Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrome in pediatric intensive care patients
Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrome in pediatric intensive care patients
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DOI：
10.1111/j.1537-2995.2010.02661.x
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发表时间：
2010-09-01
期刊：
影响因子：
2.9
通讯作者：
Tucci, Marisa
中科院分区：
文献类型：
--
作者：
Gauvin, France;Spinella, Philip C.;Tucci, Marisa
背景：目的是确定危重儿童红细胞（RBC）储存时间与新发或进展性多器官功能障碍综合征（MODS）的发展是否存在关联。研究设计和方法：这是一项随机对照试验TRIPICU（儿科重症监护病房输血要求；ISRCTN37246456）患者的分析队列分析，在该试验中，稳定的危重儿童被随机分配到限制或自由策略。使用三种不同的滑动时间截止（7、14和21天）对输血患者进行分析。多次输血患者的保存时间按输血最老单位确定。结果：共保留455例患者（自由310例，限制145例）。采用多变量逻辑回归来确定独立关联。在限制性组中，最大红细胞储存时间超过21天与新的或进展性MODS独立相关（调整优势比[or]， 3.29； 95%可信区间[CI]， 1.21-9.04）。在超过14天的储存时间中，自由组也发现了相同的关联（校正OR为2.50；95% CI为1.12-5.58）。当两组合并进行meta分析时，超过14天的存储时间与MODS升高独立相关（校正OR， 2.23; 95% CI, 1.20-4.15），超过21天的存储时间与儿科逻辑器官功能障碍（PELOD）评分升高相关（校正平均差值，4.26;95% CI, 1.99-6.53）和更高的死亡率相关（9.2%对3.8%）。结论：接受红细胞储存时间超过2 ~ 3周的稳定危重患儿发生新的或进展性MODS的风险较大。
BACKGROUND:The objective was to determine if there is an association between red blood cell (RBC) storage time and development of new or progressive multiple organ dysfunction syndrome (MODS) in critically ill children.STUDY DESIGN AND METHODS:This was an analytic cohort analysis of patients enrolled in a randomized controlled trial, TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units; ISRCTN37246456), in which stable critically ill children were randomly assigned to a restrictive or liberal strategy. Transfused patients were analyzed using three different sliding time cutoffs (7, 14, and 21 days). Storage time for multiply transfused patients was defined according to the oldest unit transfused.RESULTS:A total of 455 patients were retained (liberal, 310; restrictive, 145). Multivariate logistic regression was performed to determine independent associations. In the restrictive group, a maximum RBC storage time of more than 21 days was independently associated with new or progressive MODS (adjusted odds ratio [OR], 3.29; 95% confidence interval [CI], 1.21-9.04). The same association was found in the liberal group for a storage time of more than 14 days (adjusted OR, 2.50; 95% CI, 1.12-5.58). When the two groups were combined in a meta-analysis, a storage time of more than 14 days was independently associated with increased MODS (adjusted OR, 2.23; 95% CI, 1.20-4.15) and more than 21 days was associated with increased Pediatric Logistic Organ Dysfunction (PELOD) scores (adjusted mean difference, 4.26; 95% CI, 1.99-6.53) and higher mortality (9.2% vs. 3.8%).CONCLUSION:Stable critically ill children who receive RBC units with storage times longer than 2 to 3 weeks may be at greater risk of developing new or progressive MODS.