Blood transfusion, independent of shock severity, is associated with worse outcome in trauma
Blood transfusion, independent of shock severity, is associated with worse outcome in trauma
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DOI：
10.1097/01.ta.0000060261.10597.5c
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发表时间：
2003-05-01
影响因子：
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通讯作者：
Napolitano, LM
中科院分区：
文献类型：
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作者：
Malone, DL;Dunne, J;Napolitano, LM
背景：我们先前已经证明，在控制创伤严重程度评分、格拉斯哥昏迷评分和年龄的情况下，在最初24小时内输血是死亡率、重症监护病房(ICU)入院和在急性创伤环境中住院时间增加的独立预测因子。在这项研究中，休克的指标，如碱基缺失、血清乳酸水平、入院血流动力学状态(收缩压、心率)和入院时的红细胞压积被认为是潜在的混杂变量。这项研究的目的是评估入院贫血和最初24小时内的输血作为死亡率、ICU入院时间(LOS)和住院LOS的独立预测因素，并将血清乳酸水平、基础缺乏率和休克指数(心率/收缩压)作为协变量。方法：收集了3年(1998-2000年)I级创伤中心收治的15,534名患者的前瞻性数据，并按年龄、性别、种族、格拉斯哥昏迷评分和损伤严重程度评分进行分层。结果：输血是死亡率的独立预测因素(优势比[OR]，2.83；95%可信区间[CI]，1.82-4.40；P<；0.001)，ICU入院(OR，3.27；95%CI，2.69-3.99；P<；0.001)，ICU LOS(P<；0.001)。0.001)和医院LOS(Coef，4.37；95%CI，2.79-5.94；p<；0.001)，当按休克指数(碱缺乏、血清乳酸、休克指数和贫血)分层时。输血不足的患者死亡的可能性几乎是对照组的三倍，进入ICU的可能性是对照组的三倍以上。入院贫血(红细胞压积和Lt；36%)是ICU入院(p=0.008)、ICU LOS(p=0.012)和医院LOS(p<；0.001)的独立预测因子。在通过入院基础缺陷、乳酸、休克指数和贫血控制休克的严重程度后，输血被确认为创伤中死亡率、ICU入院、ICU LOS和医院LOS的独立预测因子。在急性损伤后使用其他基于血红蛋白的携氧复苏液(如人或牛的血红蛋白替代品)值得进一步研究。
Background: We have previously shown that blood transfusion in the first 24 hours is an independent predictor of mortality, intensive care unit (ICU) admission, and increased ICU length of stay in the acute trauma setting when controlling for Injury Severity Score, Glasgow Coma Scale score, and age. Indices of shock such as base deficit, serum lactate level, and admission hemodynamic status (systolic blood pressure, heart rate) and admission hematocrit were considered potential confounding variables in that study. The objectives of this study were to evaluate admission anemia and blood transfusion within the first 24 hours as independent predictors of mortality, ICU admission, ICU length of stay (LOS), and hospital LOS, with serum lactate level, base deficit, and shock index (heart rate/systolic blood pressure) as covariates.Methods: Prospective data were collected on 15,534 patients admitted to a Level I trauma center over a 3-year period (1998-2000) and stratified by age, gender, race, Glasgow Coma Scale score, and Injury Severity Score. Admission anemia and blood transfusion were assessed as independent predictors of mortality, ICU admission, ICU LOS, and hospital LOS by logistic regression analysis, with base deficit, serum lactate, and shock index as covariates.Results: Blood transfusion was a strong independent predictor of mortality (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.82-4.40; p < 0.001), ICU admission (OR, 3.27; 95% CI, 2.69-3.99; p < 0.001), ICU LOS (p < 0.001), and hospital LOS (Coef, 4.37; 95% CI, 2.79-5.94; p < 0.001) when stratified by indices of shock (base deficit, serum lactate, shock index, and anemia). Patients who under-went blood transfusion were almost three times more likely to die and greater than three times more likely to be admitted to the ICU. Admission anemia (hematocrit < 36%) was an independent predictor of ICU admission (p = 0.008), ICU LOS (p = 0.012), and hospital LOS (p < 0.001).Conclusion:. Blood transfusion is confirmed as an independent predictor of mortality, ICU admission, ICU LOS, and hospital LOS in trauma after controlling for severity of shock by admission base deficit, lactate, shock index, and anemia. The use of other hemoglobin-based oxygen-carrying resuscitation fluids (such as human or bovine hemoglobin substitutes) in the acute postinjury period warrants further investigation.