TRANSFUSION-RELATED RISK OF SECONDARY BACTERIAL INFECTIONS IN SEPSIS PATIENTS: A RETROSPECTIVE COHORT STUDY
TRANSFUSION-RELATED RISK OF SECONDARY BACTERIAL INFECTIONS IN SEPSIS PATIENTS: A RETROSPECTIVE COHORT STUDY
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DOI：
10.1097/shk.0b013e3182086094
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发表时间：
2011-04-01
期刊：
影响因子：
3.1
通讯作者：
Binnekade, Jan M.
中科院分区：
文献类型：
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作者：
Juffermans, Nicole P.;Prins, David J.;Binnekade, Jan M.
有必要深入了解导致败血症患者晚期死亡的因素。免疫调节作用被归因于输血。这项回顾性队列研究调查了脓毒症初期幸存者医院细菌感染的发生与输注去白细胞红细胞(RBCs)或血小板(PLT)之间的关系。入院后被诊断为脓毒症的患者包括在三级转诊医院的重症监护病房。在134例脓毒症患者中，67例接受了输血(50%)。继发感染19例(14%)。多因素Logistic回归模型显示，使用免疫抑制药物是院内感染的危险因素，OR值为1.17(95%可信区间为1.04-1.31)，而不是急性生理学和慢性健康评估II评分、恶性肿瘤、HIV感染、酗酒或糖尿病。在调整后的模型中，输血红细胞数量与继发感染相关，OR为1.18(95%CI，1.01-1.37)。红细胞保存时间是影响红细胞数量对感染影响的相关因素，其校正OR值为1.25(95%CI，1.04~1.51)，P=0.02。输注血小板数量与继发感染有关，OR值为1.36(95%CI，1.05~1.78)。总之，输注红细胞和血小板与脓毒症患者继发细菌感染有关。红细胞的储存时间会影响这种增加的风险。这些发现表明，在脓毒症恢复期，输血的免疫调节作用会导致不良结果。
There is a need for insight into factors that contribute to late mortality of sepsis patients. Immunomodulatory effects have been ascribed to blood transfusion. This retrospective cohort study investigates the association between the development of nosocomial bacterial infection and transfusion of leukodepleted red blood cells (RBCs) or platelets (PLTs) in survivors of the initial phase of sepsis. Patients diagnosed with sepsis after admission to the intensive care unit of a tertiary referral hospital were included. Of 134 patients with sepsis, 67 received a blood transfusion (50%). A secondary infection developed in 19 patients (14%). A multiple logistic regression model revealed that the use of immunosuppressive medication with an odds ratio (OR) of 1.17 (95% confidence interval [CI], 1.04-1.31), but not Acute Physiology and Chronic Health Evaluation II score, malignancy, HIV infection, alcohol abuse, or diabetes mellitus, was a risk factor for nosocomial infection. In an adjusted model, the amount of transfused RBCs was associated with secondary infection with an OR of 1.18 (95% CI, 1.01-1.37). Storage time of RBCs was a relevant confounder of the effect of the amount of RBCs on infection, with an adjusted OR of 1.25 (95% CI, 1.04-1.51), P = 0.02. Also, the amount of transfused PLTs was associated with secondary infection, with an OR of 1.36 (95% CI, 1.05-1.78). In conclusion, transfusion of RBCs and PLTs is associated with the onset of secondary bacterial infection in sepsis patients. Storage time of RBCs influences this increased risk. These findings suggest that immunomodulatory effects of blood transfusion contribute to adverse outcome in the convalescent phase of sepsis.