Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer.
Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer.
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DOI：
10.1001/archinte.168.21.2377
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发表时间：
2008-11-24
影响因子：
--
通讯作者：
Lyman, Gary H.
中科院分区：
文献类型：
--
作者：
Khorana, Alok A.;Francis, Charles W.;Blumberg, Neil;Culakova, Eva;Refaai, Majed A.;Lyman, Gary H.
贫血在癌症患者中很常见，但使用促红细胞生成素（ESAs）治疗存在顾虑。输血通常被用作替代方案，但关于结果的数据很少。我们调查了住院癌症患者输血、静脉血栓栓塞（VTE）、动脉血栓栓塞（ATE）和死亡率之间的关系。我们使用大学健康系统联盟的出院数据库进行了一项回顾性队列研究。其中包括1995年至2003年间在美国60个医疗中心住院的504,208名癌症患者。在纳入的患者中，70542例（14.0%）接受了至少1次红细胞（RBC）输血，15237例（3%）接受了至少1次血小板输血。在接受红细胞输血的患者中，7.2%发生静脉血栓栓塞（VTE）， 5.2%发生ATE，显著高于其余研究人群的3.8%和3.1% （P<0.0001）。在多因素分析中，RBC [OR 1.60, (95%CI 1.53-1.67)]和血小板输注[OR 1.20(95% CI 1.11-1.29)]与静脉血栓栓塞（VTE）风险增加独立相关。RBC [OR 1.53 (95%CI 1.46-1.61)]和血小板输注[OR 1.55 (95%CI 1.40-1.71)]也与ATE相关（P<0.0001）。输血也与院内死亡风险增加相关[红细胞OR为1.34 (95% CI 1.29-1.38)，血小板OR为2.40 (95% CI 2.27-2.52), p<0.0001]。红细胞和血小板输注与住院癌症患者静脉和动脉血栓形成事件和死亡率增加相关。要确定这种关系是否有因果关系，还需要进一步的调查。
Anemia is frequent in cancer patients, but there are concerns regarding treatment with erythropoiesis-stimulating agents (ESAs). Blood transfusions are commonly used as an alternative, but with little data regarding outcomes. We investigated the association between transfusions, venous thromboembolism (VTE), arterial thromboembolism (ATE) and mortality in hospitalized cancer patients. We conducted a retrospective cohort study using the discharge database of the University HealthSystem Consortium. This included 504,208 hospitalizations of cancer patients between 1995 and 2003 at 60 United States medical centers. Of the patients included, 70,542 (14.0%) received at least 1 red blood cell (RBC) and 15,237 (3%) received at least 1 platelet transfusion. Among patients receiving RBC transfusions, 7.2% developed VTE and 5.2% developed ATE and this was significantly greater than rates of 3.8% and 3.1%, respectively, for the rest of the study population (P<0.0001 In multivariate analysis, both RBC [OR 1.60, (95%CI 1.53–1.67)] and platelet transfusion [OR 1.20(95% CI 1.11–1.29)] were independently associated with an increased risk of VTE. RBC [OR 1.53 (95%CI 1.46–1.61)] and platelet transfusion [OR 1.55 (95%CI 1.40–1.71)] were also associated with ATE (P<0.0001 for each). Transfusions were also associated with an increased risk of in-hospital mortality [OR 1.34 (95% CI 1.29–1.38) for RBC and 2.40 (95% CI 2.27–2.52) for platelets, p<0.0001]. RBC and platelet transfusions are associated with an increased risk of venous and arterial thrombotic events and mortality in hospitalized cancer patients. Further investigation is necessary to determine whether this relationship is causal.
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影响因子：
158.5
作者：
Wu, WC;Rathore, SS;Krumholz, HM
通讯作者：
Krumholz, HM
影响因子：
6.2
作者：
Khorana, AA;Francis, CW;Lyman, GH
通讯作者：
Lyman, GH
影响因子：
45.3
作者：
Leyland-Jones, B;Semiglazov, V;Vercammen, E
通讯作者：
Vercammen, E
DOI：
10.1302/0301-620x.83b5.10560
发表时间：
2001-07-01
影响因子：
--
作者：
Bae, H;Westrich, GH;Reich, LM
通讯作者：
Reich, LM
影响因子：
--
作者：
KNIFFIN, WD;BARON, JA;ANDERSON, FA
通讯作者：
ANDERSON, FA