Bilgin Y M, van de Watering L M G, Eijsman L, Versteegh M I M, van Oers M H J, Brand A
Department of Hematology, Academical Medical Center, Amsterdam, The Netherlands.
Transfus Med. 2007 Aug;17(4):304-11. doi: 10.1111/j.1365-3148.2007.00746.x.
In two randomized trials in cardiac surgery we observed that leukoreduced allogeneic red blood cell (RBC) transfusions (LR) compared with standard buffy-coat-depleted RBC transfusions (BCD) resulted in lower rates of post-operative infections and mortality. To unravel whether this comprises two independent side effects or could be related complications of allogeneic leukocytes, we performed a re-analysis on the patients of these two trials. For all analyses, homogeneity tests were shown not to be significant. Data on characteristics of post-operative infections, nature of microorganisms, number of transfusions and causes of death in both studies were subjected to an integrated analysis. In both studies combined, 1085 patients had been assigned to prestorage leukoreduced RBCs (LR, n= 542) or standard buffy-coat-depleted RBCs (BCD, n= 543). Post-operative infections were significantly higher in the BCD group [BCD: 34.2% vs. LR: 24.0%, common odds ratios (COR): 1.65, 95% confidence interval (CI): 1.27-2.15], whereas the species of cultured microorganisms and the type of the infections were similar in both randomization arms. Mortality with infections was significantly higher in patients receiving BCD compared with LR (BCD: 5.5% vs. LR: 2.2%, COR: 2.59, 95% CI: 1.31-5.14), whereas mortality without infections was similar in both arms (BCD: 3.9% vs. LR: 3.1%, COR: 1.24, 95% CI: 0.65-2.38). The only cause of death that differed significantly between BCD and LR was the combination of multiple organ dysfunction syndrome with infections. This re-analysis shows that transfusion of leukocytes containing RBCs during cardiac surgery may be associated with more infections with fatal outcome. This should be confirmed in a larger extended analysis or a prospective study.
在两项心脏手术随机试验中，我们观察到，与标准去白膜红细胞输血（BCD）相比，白细胞滤除的异体红细胞输血（LR）可降低术后感染率和死亡率。为了弄清楚这是两个独立的副作用，还是异体白细胞的相关并发症，我们对这两项试验的患者进行了重新分析。所有分析均显示，同质性检验无显著性差异。对两项研究中术后感染特征、微生物种类、输血量及死亡原因的数据进行了综合分析。两项研究共纳入1085例患者，其中542例被分配接受储存前白细胞滤除红细胞（LR）输血，543例被分配接受标准去白膜红细胞（BCD）输血。BCD组术后感染率显著高于LR组[BCD组：34.2% vs. LR组：24.0%，共同比值比（COR）：1.65，95%置信区间（CI）：1.27 - 2.15]，而两个随机分组组中培养出的微生物种类和感染类型相似。接受BCD输血的患者感染相关死亡率显著高于LR组（BCD组：5.5% vs. LR组：2.2%；COR：2.59，95%CI：1.31 - 5.14），而未感染患者的死亡率在两组中相似（BCD组：3.9% vs. LR组：3.1%；COR：1.24，95%CI：0.65 - 2.38）。BCD组和LR组之间唯一有显著差异的死亡原因是多器官功能障碍综合征合并感染。这项重新分析表明，心脏手术期间输注含白细胞的红细胞可能与更多致命性感染有关。这一点应在更大规模的扩展分析或前瞻性研究中得到证实。
