Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: myth or reality?
Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: myth or reality?
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DOI：
10.1111/j.1537-2995.2009.02211.x
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发表时间：
2009-07-01
期刊：
影响因子：
2.9
通讯作者：
Vincent, Jean-Louis
中科院分区：
文献类型：
--
作者：
Lelubre, Christophe;Piagnerelli, Michael;Vincent, Jean-Louis
背景：输血前红细胞 (RBC) 储存的时间可能会改变红细胞功能，从而影响并发症的发生率。 研究设计和方法：通过 1983 年至 2008 年的计算机文献检索，确定了 27 项报告成年患者输注红细胞年龄与生理变量或并发症发生率之间关系的研究。 结果：排除了三项研究（仅一项摘要，两项外语）。其余 24 项研究根据患者群体进行分组：心脏手术（8 项研究）、结直肠手术（3 项）、重症监护病房（ICU；7 项）和创伤（6 项）。这些研究的异质性太强，无法进行正式的荟萃分析。 24 项研究中有 21 项是单中心研究，12 项是回顾性研究。患者数量差异很大，从 15 人到 6002 人不等。在心脏手术中，两项研究报告死亡风险增加，但存在统计局限性。在结直肠手术中，两项研究在同一数据库中探讨了对术后感染的影响，但采用不同的设计，得出了相互矛盾的结果。在普通 ICU 患者中，两项回顾性研究报告了红细胞储存时间与微循环改变或死亡率之间存在显着相关性，但该结果并未在随后的前瞻性双盲研究中得到证实。在创伤方面，五项研究报告了红细胞年龄与感染、多器官功能障碍或死亡率之间的相关性。结论：从目前公布的数据来看，很难确定输注红细胞的年龄与成年患者的结局之间是否存在关系，接受大量输血的创伤患者除外。
BACKGROUND:The duration of red blood cell (RBC) storage before transfusion may alter RBC function and, therefore, influence the incidence of complications.STUDY DESIGN AND METHODS:With a computerized literature search from 1983 to 2008, 27 studies reporting the relationship between age of transfused RBCs and physiologic variables or incidence of complications in adult patients were identified.RESULTS:Three studies (one abstract only, two foreign language) were excluded. The 24 remaining studies were grouped according to the patient population: cardiac surgery (eight studies), colorectal surgery (three), intensive care unit (ICU; seven), and trauma (six). The studies were too heterogeneous to allow a formal meta-analysis. Twenty-one of the 24 studies were single-center, and 12 were retrospective. The number of patients was highly variable, ranging from 15 to 6002. In cardiac surgery, two studies reported an increased risk of mortality but had statistical limitations. In colorectal surgery, two studies that addressed the effect on postoperative infections in the same database but with different designs yielded conflicting results. In general ICU patients, two retrospective studies reported a significant correlation between length of RBC storage and microcirculatory alterations or mortality, but the results were not confirmed in subsequent prospective, double-blinded studies. In trauma, five studies reported a correlation between RBC age and development of infection, multiple organ dysfunction, or mortality.CONCLUSIONS:From the currently available published data, it is difficult to determine whether there is a relationship between the age of transfused RBCs and outcome in adult patients, except possibly in trauma patients receiving massive transfusion.