Transfusion of platelets, but not of red blood cells, is independently associated with nosocomial infections in the critically ill
Transfusion of platelets, but not of red blood cells, is independently associated with nosocomial infections in the critically ill
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DOI：
10.1186/s13613-016-0173-1
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发表时间：
2016-07-19
影响因子：
8.1
通讯作者：
Juffermans, Nicole P.
中科院分区：
文献类型：
--
作者：
Engele, Leo J.;Straat, Marleen;Juffermans, Nicole P.
背景：红细胞输注与危重症患者医院感染有关。然而，这种相关性可能会受到住院时间的混淆，因为重症监护室（ICU）住院时间延长会增加感染风险和输血风险。此外，它是不知道是否特定的血液制品有差异risks.Methods：在这个前瞻性多中心队列研究中，与输血产品在危重病（ICU）患者的细菌感染的风险进行了测定，在一个综合的统计模型，使用考克斯比例风险分析，以解释磨损偏倚。在2011年1月1日至2012年12月31日期间住院时间> 48 h的所有急性入院患者中，使用CDC标准前瞻性监测ICU医院感染的发生。与无感染的患者相比，这些患者的APACHE IV评分更高，ICU住院时间更长，输血频率更高。Logistic回归分析显示，红细胞输注是感染的危险因素[比值比（OR）1.98，95%置信区间（CI）1.54-2.55，p < 0.001]，以及红细胞输注单位数（OR 1.04，95% CI 1.03-1.06，p < 0.001）。然而，这些关联在考克斯比例风险分析中消失。相比之下，我们发现血浆输注和感染之间存在相关性[风险比（HR）1.36，95% CI 1.10-1.69，p = 0.004]，血小板输注和感染之间存在相关性（HR 1.46，95% CI 1.18-1.81，p < 0.001）。然而，只有血小板输注与感染独立于其他输血产品（HR 1.40，95% CI 1.03-1.90，p = 0.03）。结论：在危重患者中，输注血小板，而不是红细胞和血浆，是获得医院感染的独立危险因素。
Background: Red blood cell (RBC) transfusion has been associated with nosocomial infection in the critically ill patients. However, this association may be confounded by length of stay, as prolonged intensive care unit (ICU stay) increases both risk of infection and risk of transfusion. Also, it is not known whether specific blood products have differential risks.Methods: In this prospective multicentre cohort study, the risk of bacterial infections associated with transfusion products in critically ill (ICU) patients was determined in an integrated statistical model, using Cox proportional hazard analysis to account for attrition bias. In all acutely admitted patients with a length of stay of > 48 h between 1 January 2011 and 31 December 2012, the occurrence of nosocomial infections in the ICU was prospectively monitored using CDC criteria.Results: Of 3502 screened patients, 476 (13.6 %) developed a nosocomial infection. These patients had higher APACHE IV scores, had longer ICU length of stay and were more frequently transfused compared to patients without an infection. Logistic regression showed that RBC transfusion was a risk factor for infection [odds ratio (OR) 1.98, 95 % confidence interval (CI) 1.54-2.55, p < 0.001], as well the number of RBC units transfused (OR 1.04, 95 % CI 1.03-1.06, p < 0.001). However, these associations disappeared in the Cox proportional hazard analysis. In contrast, we found an association between plasma transfusion and infection [hazard ratio (HR) 1.36, 95 % CI 1.10-1.69, p = 0.004] and between platelet transfusion and infection (HR 1.46, 95 % CI 1.18-1.81, p < 0.001). However, only platelet transfusion was associated with infection independently from other transfusion products (HR 1.40, 95 % CI 1.03-1.90, p = 0.03).Conclusions: In critically ill patients, transfusion of platelets, but not of RBCs and plasma, is an independent risk factor for acquiring a nosocomial infection.