Baer V L, Lambert D K, Henry E, Snow G L, Sola-Visner M C, Christensen R D
Department of Women and Newborns, Intermountain Healthcare, McKay-Dee Hospital Center, Ogden, UT, USA.
J Perinatol. 2007 Dec;27(12):790-6. doi: 10.1038/sj.jp.7211833. Epub 2007 Sep 13.
Several studies have indicated a correlation between the number of platelet transfusions received by newborn intensive care unit (NICU) patients and the mortality rate. The number of platelet transfusions might be a marker for level of illness, and thus predictive of mortality. However, an alternative hypothesis is that multiple platelet transfusions themselves are harmful in this population.
We evaluated data from all thrombocytopenic neonates cared for in the Intermountain Healthcare NICUs in the past 4 years, seeking associations between the lowest platelet count recorded, number of platelet transfusions received and mortality rate. We also conducted a sensitivity analysis to examine the hypothesis that platelet transfusions were responsible for some fraction of the mortality rate.
Transfusion and outcome data were examined from 1600 thrombocytopenic NICU patients. At any level of platelet count, some patients received platelet transfusions but others did not. However, at all levels of platelet count, those that received platelet transfusions had a higher mortality rate. Neonates not given any platelet transfusions had a mortality rate of 2%, those with 1 or 2 transfusions had a mortality rate of 11% (P<0.001); those with >10 had a mortality rate of 35% (P<0.001); and those with > or = 20 had a mortality rate of 50% (P<0.001). A sensitivity analysis suggested that the platelet transfusions themselves were very likely responsible for some fraction of the increasing mortality rate.
The number of platelet transfusions administered in the NICU predicts the mortality rate. Some of this correlation is ascribable to unknown and unmeasured factors such as level of illness. However, the present data and the sensitivity analysis both suggest that some of this correlation is due to harmful effects of multiple platelet transfusions in this group of patients.
多项研究表明，新生儿重症监护病房（NICU）患者接受血小板输注的次数与死亡率之间存在关联。血小板输注次数可能是疾病严重程度的一个指标，因此可预测死亡率。然而，另一种假设是，多次血小板输注本身对这一人群有害。
我们评估了过去4年在山间医疗保健NICU接受治疗的所有血小板减少新生儿的数据，寻找记录的最低血小板计数、接受血小板输注的次数与死亡率之间的关联。我们还进行了敏感性分析，以检验血小板输注导致一定比例死亡率的假设。
对1600例血小板减少的NICU患者的输血和结局数据进行了检查。在任何血小板计数水平下，一些患者接受了血小板输注，而另一些患者没有。然而，在所有血小板计数水平下，接受血小板输注的患者死亡率更高。未接受任何血小板输注的新生儿死亡率为2%，接受1或2次输注的新生儿死亡率为11%（P<0.001）；接受超过10次输注的新生儿死亡率为35%（P<0.001）；接受20次及以上输注的新生儿死亡率为50%（P<0.001）。敏感性分析表明，血小板输注本身很可能导致了死亡率上升的一部分原因。
NICU中血小板输注的次数可预测死亡率。这种相关性部分归因于疾病严重程度等未知和未测量的因素。然而，目前的数据和敏感性分析均表明，这种相关性部分是由于多次血小板输注对这组患者产生的有害影响。
