Duration of red cell storage influences mortality after trauma.
Duration of red cell storage influences mortality after trauma.
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DOI：
10.1097/ta.0b013e3181fa0019
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发表时间：
2010-12
期刊：
影响因子：
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通讯作者：
Rue LW 3rd
中科院分区：
文献类型：
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作者：
Weinberg JA;McGwin G Jr;Vandromme MJ;Marques MB;Melton SM;Reiff DA;Kerby JD;Rue LW 3rd
虽然先前的研究已经确定了相对较老的红细胞（RBC）（储存≥14天）与不良后果之间的关联，但它们很难解释，因为大多数患者接受的是新旧红细胞单位的组合。为了克服这一局限性，我们比较了住院前24小时内仅接受旧红细胞和新鲜红细胞的患者的住院死亡率。在2000年1月至2009年5月间入住一级创伤中心的患者，在入院的前24小时内接受≥1单位的纯旧（≥14天）红细胞与新鲜（<14天）红细胞的对比。计算死亡率与红细胞年龄之间的风险比（rr）和95%置信区间（ci），并根据患者年龄、损伤严重程度评分、性别、新鲜冷冻血浆或血小板的接受情况、红细胞体积、脑损伤和损伤机制（钝性或穿透性）进行调整。1647名患者符合研究纳入标准。在输注1或2个红细胞单位的患者中，未发现与红细胞年龄相关的死亡率差异（校正RR， 0.97; 95% CI, 0.72-1.32）。在输血3个或更多红细胞单位的患者中，接受旧红细胞与新鲜红细胞相比，死亡率风险显著增加，调整后的RR为1.57 （95% CI, 1.14-2.15）。对于接受3个或更多单位输血的患者，平均输注旧单位和新鲜单位的数量没有差异（分别为6.05比5.47;p = 0.11）。在到达医院24小时内输血3个或更多红细胞单位的创伤患者，接受相对较老的血液与死亡风险显著增加相关。为急性伤员保留相对新鲜的红细胞单位可能是可取的。
Although previous studies have identified an association between the transfusion of relatively older red blood cells (RBCs) (storage ≥14 days) and adverse outcomes, they are difficult to interpret because the majority of patients received a combination of old and fresh RBC units. To overcome this limitation, we compared in-hospital mortality among patients who received exclusively old versus fresh RBC units during the first 24 hours of hospitalization. Patients admitted to a Level I trauma center between January 2000 and May 2009 who received ≥1 unit of exclusively old (≥14 days) vs. fresh (<14 days) RBCs during the first 24 hours of hospitalization were identified. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the association between mortality and RBC age, adjusted for patient age, Injury Severity Score, gender, receipt of fresh frozen plasma or platelets, RBC volume, brain injury, and injury mechanism (blunt or penetrating). One thousand six hundred forty-seven patients met the study inclusion criteria. Among patients who were transfused 1 or 2 RBC units, no difference in mortality with respect to RBC age was identified (adjusted RR, 0.97; 95% CI, 0.72–1.32). Among patients who were transfused 3 or more RBC units, receipt of old versus fresh RBCs was associated with a significantly increased risk of mortality, with an adjusted RR of 1.57 (95% CI, 1.14–2.15). No difference was observed concerning the mean number of old versus fresh units transfused to patients who received 3 or more units (6.05 vs. 5.47, respectively; p = 0.11). In trauma patients undergoing transfusion of 3 or more RBC units within 24 hour of hospital arrival, receipt of relatively older blood was associated with a significantly increased mortality risk. Reservation of relatively fresh RBC units for the acutely injured may be advisable.