Hill Gary E, Frawley William H, Griffith Karl E, Forestner John E, Minei Joseph P
Department of Anesthesiology and Pain Management, Parland Memorial Hospital and University of Texas Southwestern Medical Center at Dallas, 75235-9008, USA.
J Trauma. 2003 May;54(5):908-14. doi: 10.1097/01.TA.0000022460.21283.53.
Immunosuppression is a consequence of allogeneic (homologous) blood transfusion (ABT) in humans and is associated with an increased risk in cancer recurrence rates after potentially curative surgery as well as an increase in the frequency of postoperative bacterial infections. Although a meta-analysis has been reported demonstrating the relationship between ABT and colon cancer recurrence, no meta-analysis has been reported demonstrating the relationship of ABT to postoperative bacterial infection.
Twenty peer-reviewed articles published from 1986 to 2000 were included in a meta-analysis. Criteria for inclusion included a clearly defined control group (nontransfused) compared with a treated (transfused) group and statistical analysis of accumulated data that included stepwise multivariate logistic regression analysis. In addition, a subgroup of publications that included only the traumatically injured patient was included in a separate meta-analysis. A fixed effects analysis was conducted with odds ratios obtained by using the conditional maximum likelihood method and 95% confidence intervals on the obtained odds ratios were determined using the mid-p technique.
The total number of subjects included in this meta-analysis was 13,152 (5,215 in the transfused group and 7,937 in the nontransfused group). The common odds ratio for all articles included in this meta-analysis evaluating the association of ABT to the incidence of postoperative bacterial infection was 3.45 (range, 1.43-15.15), with 17 of the 20 studies demonstrating a value of p < or = 0.05. These results provide overwhelming evidence that ABT is associated with a significantly increased risk of postoperative bacterial infection in the surgical patient. The common odds ratio of the subgroup of trauma patients was 5.263 (range, 5.03-5.43), with all studies showing a value of p < 0.05 (0.005-0.0001). These results demonstrate that ABT is associated with a greater risk of postoperative bacterial infection in the trauma patient when compared with those patients receiving ABT during or after elective surgery.
These results demonstrate that ABT is an associated and apparently significant and frequently overlooked risk factor for the development of postoperative bacterial infection in the surgical patient. Allogeneic blood transfusion is a greater risk factor in the traumatically injured patient when compared with the elective surgical patient for the development of postoperative bacterial infection.
免疫抑制是人类同种异体（同源）输血（ABT）的一个后果，与根治性手术后癌症复发率增加以及术后细菌感染频率增加有关。尽管已有一项荟萃分析报告了ABT与结肠癌复发之间的关系，但尚无荟萃分析报告ABT与术后细菌感染之间的关系。
一项荟萃分析纳入了1986年至2000年发表的20篇经同行评审的文章。纳入标准包括与治疗组（输血组）相比有明确界定的对照组（未输血组）以及对累积数据进行统计分析，其中包括逐步多变量逻辑回归分析。此外，仅纳入创伤患者的一组出版物被纳入单独的荟萃分析。采用条件最大似然法获得比值比，并使用中点p技术确定所得比值比的95%置信区间，进行固定效应分析。
该荟萃分析纳入的受试者总数为13152例（输血组5215例，未输血组7937例）。该荟萃分析中评估ABT与术后细菌感染发生率相关性的所有文章的共同比值比为3.45（范围为1.43 - 15.15），20项研究中有17项显示p值≤0.05。这些结果提供了压倒性的证据，表明ABT与手术患者术后细菌感染风险显著增加有关。创伤患者亚组的共同比值比为5.263（范围为5.03 - 5.43），所有研究均显示p值<0.05（0.005 - 0.0001）。这些结果表明，与择期手术期间或术后接受ABT的患者相比，ABT与创伤患者术后细菌感染风险更高有关。
这些结果表明，ABT是手术患者术后细菌感染发生的一个相关且明显重要但经常被忽视的危险因素。与择期手术患者相比，同种异体输血在创伤患者中是术后细菌感染发生的更大危险因素。
