Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient
Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient
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DOI：
10.1097/00003246-200210000-00012
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发表时间：
2002-10-01
影响因子：
8.8
通讯作者：
Veremakis, C
中科院分区：
文献类型：
--
作者：
Taylor, RW;Manganaro, L;Veremakis, C
目的：确定接受同种异体浓缩红细胞输注的危重患者发生院内感染的风险是否增加。设计：利用 Project IMPACT 进行回顾性数据库研究。设置：一家拥有 825 个床位的三级转诊教学医院，设有 40 个床位的内外科创伤重症监护病房。患者：1717 名患者入住内科外科创伤重症监护病房。测量和主要结果：使用 Project IMPACT 数据库收集数据。比较了三组的院内感染率：整个队列、输血组和非输血组。我们确定了这些组中的医院感染率，同时通过使用死亡率预测模型 (MPM-0) 评分、年龄、性别和输注的浓缩红细胞单位数来调整生存概率。每个患者的平均输血单位数为 4.0。整个队列的医院感染率为5.94%。输血组 (n = 416) 和非输血组 (n = 1301) 的医院感染率分别为 15.38% 和 2.92% (p < .005 卡方)。浓缩红细胞的输注与院内感染的发生有关，且存在剂量反应模式（输注浓缩红细胞越多，院内感染的机会越大；p < 0.0001 卡方）。输血组发生院内感染的可能性是非输血组的六倍。此外，每输入一个单位的浓缩红细胞，发生院内感染的几率就会增加 1.5 倍。使用 MPM-O 评分根据生存概率调整医院感染率的亚组分析显示，与未输血患者相比，输血患者的医院感染发生率始终较高。根据患者年龄调整的第二个亚组分析显示，无论年龄如何，输血患者的医院感染率均出现统计学显着增加。结论：浓缩红细胞的输注与医院感染相关。当根据生存概率和年龄进行调整后，这种关联仍然存在。此外，输血患者的死亡率以及重症监护室和住院时间显着增加。
Objective: To determine whether critically ill patients who receive allogenic packed red blood cell transfusions are at increased risk of developing nosocomial. infections during hospitalization.Design: Retrospective database study utilizing Project IMPACT.Setting: A 40-bed medical-surgical-trauma intensive care unit in an 825-bed tertiary referral teaching hospital.Patients: One thousand seven hundred and seventeen patients admitted to the medical-surgical-trauma intensive care unit.Measurements and Main Results: Data were collected by using the Project IMPACT database. Nosocomial infection rates were compared among three groups: the entire cohort, the transfusion group, and the nontransfusion group. We determined the nosocomial infection rates in these groups while adjusting for probability of survival by using Mortality Prediction Model (MPM-0) scores, age, gender, and number of units of packed red blood cells transfused. The average number of units transfused per patient was 4.0. The nosocomial infection rate for the entire cohort was 5.94%. The nosocomial infection rates for the transfusion group (n = 416) and the nontransfusion group (n = 1301) were 15.38% and 2.92%, respectively (p < .005 chi-square). Transfusion of packed red blood cells was related to the occurrence of nosocomial infection, and there was a dose-response pattern (the more units of packed red blood cells transfused, the greater the chance of nosocomial infection; p < 0.0001 chi-square). The transfusion group was six times more likely to develop nosocomial infection compared with the nontransfusion group. In addition, for each unit of packed red blood cells transfused, the odds of developing nosocomial infection were increased by a factor of 1.5. A subgroup analysis of nosocomial infection rates adjusted for probability of survival by using MPM-O scores showed nosocomial infection to occur at consistently higher rates in transfused patients vs. nontransfused patients. A second subgroup analysis adjusted for patient age showed a statistically significant increase in rates of nosocomial infection for transfused patients regardless of age.Conclusions: Transfusion of packed red blood cells is associated with nosocomial infection. This association continues to exist when adjusted for probability of survival and age. In addition, mortality rates and length of intensive care unit and hospital stay are significantly increased in transfused patients.