Rüttinger Dominik, Wolf Hilde, Küchenhoff Helmut, Jauch Karl-Walter, Hartl Wolfgang H
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian University Munich, Marchioninistrasse 15, D-81377 Munich, Germany.
Shock. 2007 Aug;28(2):165-71. doi: 10.1097/shk.0b013e31803df84d.
In contrast to randomized studies, previous cohort studies identified red cell transfusion as an independent predictor of mortality in critically ill patients. However, these cohort studies did not adjust for disease severity during intensive care unit (ICU) stay. We performed a retrospective, observational cohort study using prospectively collected data from March 1, 1993, through February 28, 2005. A cohort of 3037 consecutive surgical cases requiring intensive care therapy for more than one day was analyzed. We used two different sets of potentially confounding covariables (admission variables only or in combination with variables reflecting number and extent of organ dysfunction during ICU stay). We found that the total number of red cell units which a case had received during ICU stay, and the maximum number of units given on a single day, were independently associated with an increase in ICU mortality when only admission variables were considered for the analysis. After controlling for the additional effect of variables reflecting organ dysfunction during ICU stay, we found that red cell transfusion was no longer an independent risk factor for death. However, there was a significant effect of red cell transfusion on ICU LOS in survivors irrespective of the covariable sets used. We conclude that red cell transfusion during ICU stay may be only a surrogate marker for disease severity and is not causally related to ICU mortality. Relevant side effects of red cell transfusion are presumably small and may be only recognizable in surviving cases.
与随机研究不同，先前的队列研究将红细胞输注确定为重症患者死亡率的独立预测因素。然而，这些队列研究并未对重症监护病房（ICU）住院期间的疾病严重程度进行校正。我们进行了一项回顾性观察性队列研究，使用了从1993年3月1日至2005年2月28日前瞻性收集的数据。分析了一组连续3037例需要重症监护治疗超过一天的手术病例。我们使用了两组不同的潜在混杂协变量（仅入院变量或与反映ICU住院期间器官功能障碍数量和程度的变量相结合）。我们发现，当仅考虑入院变量进行分析时，病例在ICU住院期间接受的红细胞单位总数以及单日输注的最大单位数与ICU死亡率增加独立相关。在控制了反映ICU住院期间器官功能障碍变量的额外影响后，我们发现红细胞输注不再是死亡的独立危险因素。然而，无论使用何种协变量集，红细胞输注对幸存者的ICU住院时间都有显著影响。我们得出结论，ICU住院期间的红细胞输注可能只是疾病严重程度的替代指标，与ICU死亡率没有因果关系。红细胞输注的相关副作用可能很小，可能仅在存活病例中可识别。
