Relationship between red cell storage duration and outcomes in adults receiving red cell transfusions: a systematic review.
Relationship between red cell storage duration and outcomes in adults receiving red cell transfusions: a systematic review.
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DOI：
10.1186/cc12600
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发表时间：
2013-04-08
期刊：
影响因子：
--
通讯作者：
Vincent JL
中科院分区：
文献类型：
--
作者：
Lelubre C;Vincent JL
输血前红细胞（RBC）储存的时间可能会改变RBC功能和上清液，从而影响并发症的发生率甚至死亡率。进行了1983年至2012年12月的MEDLINE检索，以识别报告输注RBC年龄和成人患者死亡率或发病率的研究。确定了55项研究;大多数是单中心（93%）和回顾性（64%），只有少数小型随机研究（8项研究，14.5%）。纳入的受试者数量从8人到364，037人不等。死亡结局包括住院和重症监护室（ICU）住院时间（LOS）、感染、多器官衰竭、微循环改变、癌症复发、血栓形成、出血、蛛网膜下腔出血后血管痉挛和认知功能障碍。总体而言，一半的研究显示，与新鲜血液相比，老化血液对任何终点都没有有害影响。22项研究中有11项（50%）报告死亡率没有增加，9项研究中有3项（33%）显示老年红细胞的LOS没有增加，12项研究中有8项（66%）显示器官衰竭的风险没有增加。18项研究中有10项（55%）显示输注较旧的RBC会增加感染。研究之间相当大的异质性和众多的方法缺陷排除了正式的荟萃分析。在这项系统性综述中，我们没有发现支持新鲜红细胞输注优于陈旧红细胞输注的明确论据。
The duration of red blood cell (RBC) storage before transfusion may alter RBC function and supernatant and, therefore, influence the incidence of complications or even mortality. A MEDLINE search from 1983 to December 2012 was performed to identify studies reporting age of transfused RBCs and mortality or morbidity in adult patients. Fifty-five studies were identified; most were single-center (93%) and retrospective (64%), with only a few, small randomized studies (eight studies, 14.5%). The numbers of subjects included ranged from eight to 364,037. Morbidity outcomes included hospital and intensive care unit (ICU) length of stay (LOS), infections, multiple organ failure, microcirculatory alterations, cancer recurrence, thrombosis, bleeding, vasospasm after subarachnoid hemorrhage, and cognitive dysfunction. Overall, half of the studies showed no deleterious effects of aged compared to fresh blood on any endpoint. Eleven of twenty-two (50%) studies reported no increased mortality, three of nine (33%) showed no increased LOS with older RBCs and eight of twelve (66%) studies showed no increased risks of organ failure. Ten of eighteen (55%) studies showed increased infections with transfusion of older RBCs. The considerable heterogeneity among studies and numerous methodological flaws precluded a formal meta-analysis. In this systematic review, we could find no definitive argument to support the superiority of fresh over older RBCs for transfusion.
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