Marque Sophie, Cariou Alain, Chiche Jean-Daniel, Mallet Vincent Olivier, Pene Frédéric, Mira Jean-Paul, Dhainaut Jean-François, Claessens Yann-Erick
Medical Intensive Care Unit, Cochin Hospital, rue du Faubourg Saint-Jacques, F-75679 Paris Cedex 14, France.
Crit Care. 2006;10(5):R129. doi: 10.1186/cc5041.
Factors predictive of the need for red blood cell (RBC) transfusion in the intensive care unit (ICU) have been identified, but risk factors for transfusion after ICU discharge are unknown. This study aims identifies risk factors for RBC transfusion after discharge from the ICU.
A prospective, monocentric observational study was conducted over a 6-month period in a 24-bed medical ICU in a French university hospital. Between June and December 2003, 550 critically ill patients were consecutively enrolled in the study.
A total of 428 patients survived after treatment in the ICU; 47 (11% of the survivors, 8.5% of the whole population) required RBC transfusion within 7 days after ICU discharge. Admission for sepsis (odds ratio [OR] 341.60, 95% confidence interval [CI] 20.35-5734.51), presence of an underlying malignancy (OR 32.6, 95%CI 3.8-280.1), female sex (OR 5.4, 95% CI 1.2-24.9), Logistic Organ Dysfunction score at ICU discharge (OR 1.45, 95% CI 1.1-1.9) and age (OR 1.06, 95% CI 1.02-1.12) were independently associated with RBC transfusion after ICU stay. Haemoglobin level at discharge predicted the need for delayed RBC transfusion. Use of vasopressors (OR 0.01, 95%CI 0.001-0.17) and haemoglobin level at discharge from the ICU (OR 0.02, 95% CI 0.007-0.09; P < 0.001) were strong independent predictors of transfusion of RBC 1 week after ICU discharge.
Sepsis, underlying conditions, unresolved organ failures and haemoglobin level at discharge were related to an increased risk for RBC transfusion after ICU stay. We suggest that strategies to prevent transfusion should focus on homogeneous subgroups of patients and take into account post-ICU needs for RBC transfusion.
已确定了重症监护病房（ICU）中预测红细胞（RBC）输血需求的因素，但ICU出院后输血的风险因素尚不清楚。本研究旨在确定ICU出院后RBC输血的风险因素。
在法国一家大学医院的24张床位的内科ICU中进行了一项为期6个月的前瞻性单中心观察性研究。2003年6月至12月期间，550例危重症患者连续纳入研究。
共有428例患者在ICU治疗后存活；47例（占存活者的11%，占总人群的8.5%）在ICU出院后7天内需要RBC输血。脓毒症入院（比值比[OR]341.60，95%置信区间[CI]20.35 - 5734.51）、存在潜在恶性肿瘤（OR 32.6，95%CI 3.8 - 280.1）、女性（OR 5.4，95%CI 1.2 - 24.9）、ICU出院时的逻辑器官功能障碍评分（OR 1.45，95%CI 1.1 - 1.9）和年龄（OR 1.06，95%CI 1.02 - 1.12）与ICU住院后RBC输血独立相关。出院时的血红蛋白水平可预测延迟RBC输血的需求。使用血管升压药（OR 0.01，95%CI 0.001 - 0.17）和ICU出院时的血红蛋白水平（OR 0.02，95%CI 0.007 - 0.09；P < 0.001）是ICU出院1周后RBC输血的强有力独立预测因素。
脓毒症、基础疾病、未解决的器官功能衰竭和出院时的血红蛋白水平与ICU住院后RBC输血风险增加有关。我们建议预防输血的策略应侧重于患者的同质亚组，并考虑ICU后RBC输血的需求。
