Intervening on the storage time of RBC units and its effects on adverse recipient outcomes using real-world data.
Intervening on the storage time of RBC units and its effects on adverse recipient outcomes using real-world data.
复制标题
介入RBC单位的存储时间及其对不良收件人结果的影响，使用现实世界中的数据。
DOI：
10.1182/blood.2022015892
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发表时间：
2022-06-23
期刊：
影响因子：
20.3
通讯作者：
Johansson, Par Ingemar
中科院分区：
文献类型：
--
作者：
Bruun-Rasmussen, Peter;Andersen, Per Kragh;Banasik, Karina;Brunak, Soren;Johansson, Par Ingemar
许多随机对照试验未能证实红细胞（RBC）年龄影响患者的生存。Bruun-Rasmussen等人利用来自丹麦国家数据库的真实世界数据对假设试验进行建模，其中包括89000名接受输血的患者，并进行了28天的随访。这些统计数据表明，只输入年龄较大的红细胞单位会增加血栓栓塞或死亡的风险。模拟使用大量真实世界数据的假设随机试验可能很适合解决先前RBC输血随机对照试验的问题。我们的研究表明，输注储存1 ~ 2周的红细胞会增加受者的死亡率。随机对照试验（rct）没有发现输血红细胞（RBC）单位的储存时间影响受体生存的证据。然而，进行红细胞输血随机对照试验的固有困难引发了对其设计、分析和解释的批评。在这里，我们通过模拟使用大量真实世界数据的假设随机试验来解决这些问题，以进一步阐明储存时间的不利影响。我们使用逆概率加权估计了只输注老红细胞与新鲜红细胞对主要死亡终点和次要血栓栓塞事件复合终点或死亡的比较影响。阈值定义为1、2、3和4周的存储。2008年至2018年期间，一个大型丹麦输血数据库包含了bb90万次输血事件，定义了观测数据。在28天的随访中，总共有89 799名患者接受了40 34万红细胞输血，符合资格标准。与完全使用较旧的红细胞单位相比，使用完全新鲜于1、2、3和4周的红细胞单位治疗可使28天受者死亡率分别降低2.44个百分点（0.86、4.02）、1.93个百分点（0.85、3.02）、1.06个百分点（-0.20、2.33）和- 0.26个百分点（-1.78、1.25）。综合终点的28天风险差异相似。这项研究表明，与输入新鲜红细胞单位相比，只输入储存了100或2周的老红细胞单位会增加28天的受者死亡率和血栓栓塞或死亡的风险。
Many randomized controlled trials have failed to confirm that red blood cell (RBC) age affects patient survival. Positing weaknesses in the design of such trials, Bruun-Rasmussen et al used modeling of hypothetical trials using real-world data from a Danish national database, including 89,000 patients receiving transfusion with a 28-day follow-up. These statistically-derived data suggest an increased risk of thromboembolism or death with transfusion of exclusively older RBC units. Emulating hypothetical randomized trials using large real-world data may be well suited to address the issues of prior RBC transfusion RCTs. Our study suggests that transfusing RBC units stored for >1 or 2 weeks increases recipient mortality. Randomized controlled trials (RCTs) have found no evidence that the storage time of transfused red blood cell (RBC) units affects recipient survival. However, inherent difficulties in conducting RBC transfusion RCTs have prompted critique of their design, analyses, and interpretation. Here, we address these issues by emulating hypothetical randomized trials using large real-world data to further clarify the adverse effects of storage time. We estimated the comparative effect of transfusing exclusively older vs fresher RBC units on the primary outcome of death, and the secondary composite end point of thromboembolic events, or death, using inverse probability weighting. Thresholds were defined as 1, 2, 3, and 4 weeks of storage. A large Danish blood transfusion database from the period 2008 to 2018 comprising >900 000 transfusion events defined the observational data. A total of 89 799 patients receiving >340 000 RBC transfusions during 28 days of follow-up met the eligibility criteria. Treatment with RBC units exclusively fresher than 1, 2, 3, and 4 weeks of storage was found to decrease the 28-day recipient mortality with 2.44 percentage points (pp) (0.86 pp, 4.02 pp), 1.93 pp (0.85 pp, 3.02 pp), 1.06 pp (–0.20 pp, 2.33 pp), and −0.26 pp (–1.78 pp, 1.25 pp) compared with transfusing exclusively older RBC units, respectively. The 28-day risk differences for the composite end point were similar. This study suggests that transfusing exclusively older RBC units stored for >1 or 2 weeks increases the 28-day recipient mortality and risk of thromboembolism or death compared with transfusing fresher RBC units.
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DOI：
10.1056/nejmoa1414219
发表时间：
2015-04-09
期刊：
The New England journal of medicine
影响因子：
--
作者：
Steiner ME;Ness PM;Assmann SF;Triulzi DJ;Sloan SR;Delaney M;Granger S;Bennett-Guerrero E;Blajchman MA;Scavo V;Carson JL;Levy JH;Whitman G;D'Andrea P;Pulkrabek S;Ortel TL;Bornikova L;Raife T;Puca KE;Kaufman RM;Nuttall GA;Young PP;Youssef S;Engelman R;Greilich PE;Miles R;Josephson CD;Bracey A;Cooke R;McCullough J;Hunsaker R;Uhl L;McFarland JG;Park Y;Cushing MM;Klodell CT;Karanam R;Roberts PR;Dyke C;Hod EA;Stowell CP
通讯作者：
Stowell CP
影响因子：
2.9
作者：
Pereira, Arturo
通讯作者：
Pereira, Arturo
影响因子：
2.9
作者：
Dzik, Walter H.;Beckman, Neil;Wendel, Silvano
通讯作者：
Wendel, Silvano
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
5
作者：
Hernan, Miguel A.;Robins, James M.
通讯作者：
Robins, James M.