Longer RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery
Longer RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery
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DOI：
10.1097/pcc.0000000000000320
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发表时间：
2015-03-01
影响因子：
4.1
通讯作者：
Blumberg, Neil
中科院分区：
文献类型：
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作者：
Cholette, Jill M.;Pietropaoli, Anthony P.;Blumberg, Neil
目的：接受心脏直视手术的婴儿和儿童通常需要多次输注红细胞。接受大量红细胞输注的儿童术后并发症和死亡率增加。较长的RBC储存年龄也与危重儿童的发病率和死亡率增加有关。在小儿先天性心脏病的心脏手术中使用新鲜红细胞是否可以改善输血量增加和不良结局的相关性尚不清楚。干预措施：一百二十-8名连续输血的儿童接受了体外循环先天性心脏病的修复或姑息治疗，他们参加了一项随机试验，比较了洗涤红细胞输注与标准红细胞输注的关系，年龄和临床结果。为了避免与输血剂量和感染时间与输血时间的混淆，对手术当天仅输1-2个单位的患者进行了亚组分析。测量和主要结果：死亡率低（4.9%），RBC储存时间与存活率之间无相关性。接受最旧血液（25-38天）的儿童的术后感染率显著高于接受最新鲜RBC（7-15天）的儿童（34% vs 7%; p = 0.004）。对手术当天仅接受1-2次RBC输注的受试者（n = 74）进行的亚组分析也表明，接受最旧RBC单位输注的受试者的感染患病率更高（0/33 [0%]储存7- 15天; 1/21 [5%]储存16- 24天; 4/20 [20%]储存25- 38天; p = 0.01）。在多变量分析中，RBC储存年龄和皮质类固醇应用是术后感染的唯一预测因素。与未清洗的RBCs.Discussion相比，清洗最老的RBC（> 27 d）与更高的感染率和发病率相关：较长的RBC储存时间与术后医院感染增加相关。这种关联可能是次要的部分，从单供体单位输入的大剂量储存的红细胞。清洗最老的红细胞与发病率增加有关，可能是由于清洗程序引起的更老、更脆弱的红细胞破坏增加。需要进一步研究红细胞储存年龄对小儿心脏手术术后感染率的影响。
Objectives: Infants and children undergoing open heart surgery routinely require multiple RBC transfusions. Children receiving greater numbers of RBC transfusions have increased postoperative complications and mortality. Longer RBC storage age is also associated with increased morbidity and mortality in critically ill children. Whether the association of increased transfusions and worse outcomes can be ameliorated by use of fresh RBCs in pediatric cardiac surgery for congenital heart disease is unknown.Interventions: One hundred and twenty-eight consecutively transfused children undergoing repair or palliation of congenital heart disease with cardiopulmonary bypass who were participating in a randomized trial of washed versus standard RBC transfusions were evaluated for an association of RBC storage age and clinical outcomes. To avoid confounding with dose of transfusions and timing of infection versus timing of transfusion, a subgroup analysis of patients only transfused 1-2 units on the day of surgery was performed.Measurements and Main Results: Mortality was low (4.9%) with no association between RBC storage duration and survival. The postoperative infection rate was significantly higher in children receiving the oldest blood (25-38 d) compared with those receiving the freshest RBCs (7-15 d) (34% vs 7%; p = 0.004). Subgroup analysis of subjects receiving only 1-2 RBC transfusions on the day of surgery (n = 74) also demonstrates a greater prevalence of infections in subjects receiving the oldest RBC units (0/33 [0%] with 7-to 15-day storage; 1/21 [5%] with 16-to 24-day storage; and 4/20 [20%] with 25-to 38-day storage; p = 0.01). In multivariate analysis, RBC storage age and corticosteroid administration were the only predictors of postoperative infection. Washing the oldest RBCs (> 27 d) was associated with a higher infection rate and increased morbidity compared with unwashed RBCs.Discussion: Longer RBC storage duration was associated with increased postoperative nosocomial infections. This association may be secondary in part, to the large doses of stored RBCs transfused, from single-donor units. Washing the oldest RBCs was associated with increased morbidity, possibly from increased destruction of older, more fragile erythrocytes incurred by washing procedures. Additional studies examining the effect of RBC storage age on postoperative infection rate in pediatric cardiac surgery are warranted.