Effects of red-cell storage duration on patients undergoing cardiac surgery.
Effects of red-cell storage duration on patients undergoing cardiac surgery.
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DOI：
10.1056/nejmoa1414219
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发表时间：
2015-04-09
期刊：
影响因子：
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通讯作者：
Stowell CP
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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
一些观察性研究报告称，输注储存超过 2 至 3 周的红细胞单位会导致严重甚至致命的不良事件。接受心脏手术的患者可能特别容易受到输血的不利影响。我们从2010年到2014年在多个地点进行了一项随机试验。12岁或以上接受复杂心脏手术且可能接受红细胞输注的参与者被随机分配接受储存10天或更少（短期储存组）或21天或以上（长期储存组）的白细胞减少红细胞，用于所有术中和术后输血。主要结局是多器官功能障碍评分（MODS；范围为 0 至 24，评分越高表示器官功能障碍越严重）从术前评分到第 7 天或死亡或出院时最高综合评分的变化。向接受红细胞输注的 1098 名参与者提供的红细胞单位的中位储存时间在短期储存组中为 7 天，在长期储存组中为 28 天。 MODS 的平均变化分别增加了 8.5 点和 8.7 点（差异的 95% 置信区间为 -0.6 至 0.3；P = 0.44）。短期储存组的 7 天死亡率为 2.8%，长期储存组为 2.0%（P = 0.43）； 28 天死亡率分别为 4.4% 和 5.3%（P = 0.57）。除了高胆红素血症在长期储存组中更常见之外，各组之间的不良事件没有显着差异。红细胞储存的持续时间与 MODS 变化的显着差异无关。我们没有发现，在 12 岁或以上接受复杂心脏手术的患者中，输注储存 10 天或更少的红细胞优于输注储存 21 天或更长的红细胞。 （由国家心肺血液研究所资助；RECESS ClinicalTrials.gov 编号，NCT00991341。）
Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, −0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (P = 0.43); 28-day mortality was 4.4% and 5.3%, respectively (P = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery. (Funded by the National Heart, Lung, and Blood Institute; RECESS ClinicalTrials.gov number, NCT00991341.)