The effect of age and clinical circumstances on the outcome of red blood cell transfusion in critically ill patients.
The effect of age and clinical circumstances on the outcome of red blood cell transfusion in critically ill patients.
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DOI：
10.1186/s13054-014-0487-z
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发表时间：
2014-08-30
期刊：
影响因子：
--
通讯作者：
Celi LA
中科院分区：
文献类型：
--
作者：
Dejam A;Malley BE;Feng M;Cismondi F;Park S;Samani S;Samani ZA;Pinto DS;Celi LA
红细胞（RBC）输注是否有益仍存在争议。在回顾性和前瞻性评估中，输血与不良、中性或保护性作用相关。这些不同的结果可能源于输血、患者特征和临床背景之间复杂的相互作用。目的是测试年龄、合并症和临床背景是否会调节输血对生存的影响。我们利用重症监护II数据库多参数智能监测（v.2.6），对9809例危重症患者进行回顾性分析，评估红细胞输注对30天和1年死亡率的影响。倾向评分模型和逻辑回归针对已知的混杂因素进行了调整，并评估了输血对 30 天和 1 年死亡率的独立影响。使用 3,164 对输血和非输血对进行敏感性分析，并根据先前验证的红细胞输血倾向模型进行匹配。红细胞输注并不影响整个队列的 30 天或 1 年死亡率。 55 岁以下的患者因输血而死亡的几率增加（OR，1.71；P<0.01）。 75 岁以上的患者输血后 30 天和 1 年死亡率较低（OR，0.70；P<0.01）。接受心脏手术的患者输血与较差的预后相关（OR，2.1；P<0.01）。倾向匹配人群证实了回归调整确定的结果。红细胞输注与临床结果之间存在复杂的关系。我们的结果表明，根据合并症和患者特征，输血与某些队列的结局改善有关，而另一些队列的结局则较差。因此，评估输血价值的未来研究和临床决策应考虑基线特征和临床背景的变化。本文的在线版本 (doi:10.1186/s13054-014-0487-z) 包含补充材料，可供授权用户使用。
Whether red blood cell (RBC) transfusion is beneficial remains controversial. In both retrospective and prospective evaluations, transfusion has been associated with adverse, neutral, or protective effects. These varying results likely stem from a complex interplay between transfusion, patient characteristics, and clinical context. The objective was to test whether age, comorbidities, and clinical context modulate the effect of transfusion on survival. By using the multiparameter intelligent monitoring in intensive care II database (v. 2.6), a retrospective analysis of 9,809 critically ill patients, we evaluated the effect of RBC transfusion on 30-day and 1-year mortality. Propensity score modeling and logistic regression adjusted for known confounding and assessed the independent effect of transfusion on 30-day and 1-year mortality. Sensitivity analysis was performed by using 3,164 transfused and non-transfused pairs, matched according the previously validated propensity model for RBC transfusion. RBC transfusion did not affect 30-day or 1-year mortality in the overall cohort. Patients younger than 55 years had increased odds of mortality (OR, 1.71; P < 0.01) with transfusion. Patients older than 75 years had lower odds of 30-day and 1-year mortality (OR, 0.70; P < 0.01) with transfusion. Transfusion was associated with worse outcome among patients undergoing cardiac surgery (OR, 2.1; P < 0.01). The propensity-matched population corroborated findings identified by regression adjustment. A complex relation exists between RBC transfusion and clinical outcome. Our results show that transfusion is associated with improved outcomes in some cohorts and worse outcome in others, depending on comorbidities and patient characteristics. As such, future investigations and clinical decisions evaluating the value of transfusion should account for variations in baseline characteristics and clinical context. The online version of this article (doi:10.1186/s13054-014-0487-z) contains supplementary material, which is available to authorized users.
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