Cryoprecipitate for the treatment of life-threatening hemorrhage in children.
Cryoprecipitate for the treatment of life-threatening hemorrhage in children.
复制标题
冷沉淀用于治疗儿童危及生命的出血。
DOI：
10.1111/trf.17340
复制
发表时间：
2023
期刊：
影响因子：
2.9
通讯作者：
Leeper,ChristineM
中科院分区：
文献类型：
--
作者：
Horst,JenniferA;Spinella,PhilipC;Leonard,JulieC;Josephson,CassandraD;Leeper,ChristineM
背景低纤维蛋白原血症是严重出血儿童预后不良的重要危险因素。关于冷沉淀输注对危及生命的出血 (LTH) 儿科患者结局的影响的数据很少。研究设计和方法这项针对 LTH 儿童的多中心前瞻性观察研究的二次分析调查了根据复苏期间接受冷沉淀并根据出血病因（创伤、手术和内科）对受试者进行分类的受试者。进行双变量分析以确定与 6 小时、24 小时和 28 天死亡率相关的变量。生成 Cox Hazard 回归模型以调整潜在的混杂因素。结果 33.9% (152/449) 的儿童在 LTH 期间输注了冷沉淀。冷沉淀给药的中位时间（四分位数范围）为 108 (47–212) 分钟。冷沉淀组的儿童年龄较小，女性较多，BMI 和 LTH PRISM 评分较高，血小板计数较低。调整 PRISM 评分、出血病因、年龄、性别、红细胞体积、血小板体积、抗纤溶药物使用和心脏骤停后，冷沉淀给药与较低的 6 小时死亡率独立相关，风险比 (95% CI)，0.41 (0.19–0.89)，(p= 0.02) 和 24 小时死亡率，风险比 (95% CI)，0.46 (0.24–0.89), (p= 0.02)。结论 LTH 儿童进行冷沉淀输血与早期死亡率降低相关。需要进行前瞻性随机试验来确定冷沉淀是否可以改善 LTH 儿童的预后。
BackgroundHypofibrinogenemia is an important risk factor for poor outcomes in children with severe bleeding. There is a paucity of data on the impact of cryoprecipitate transfusion on outcomes in pediatric patients with life‐threatening hemorrhage (LTH).Study Design and MethodsThis secondary analysis of a multicenter prospective observational study of children with LTH investigated subjects who were categorized by receipt of cryoprecipitate during their resuscitation and according to the etiology of their bleeding: trauma, operative, and medical. Bivariate analysis was performed to identify variables associated with 6‐h, 24‐h, and 28‐day mortality. Cox Hazard regression models were generated to adjust for potential confounders.ResultsCryoprecipitate was transfused to 33.9% (152/449) of children during LTH. The median (Interquartile range) time to cryoprecipitate administration was 108 (47–212) minutes. Children in the cryoprecipitate group were younger, more often female, with higher BMI and pre‐LTH PRISM score and lower platelet counts. After adjusting for PRISM score, bleeding etiology, age, sex, RBC volume, platelet volume, antifibrinolytic use and cardiac arrest, cryoprecipitate administration was independently associated with lower 6‐h mortality, Hazard Ratio (95% CI), 0.41 (0.19–0.89), (p= 0.02) and 24‐h mortality, Hazard Ratio (95% CI), 0.46 (0.24–0.89), (p= 0.02).ConclusionCryoprecipitate transfusion to children with LTH was associated with reduced early mortality. A prospective randomized trial is needed to determine if cryoprecipitate can improve outcomes in children with LTH.