Vincent Jean-Louis, Sakr Yasser, Sprung Charles, Harboe Svein, Damas Pierre
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
Anesthesiology. 2008 Jan;108(1):31-9. doi: 10.1097/01.anes.0000296070.75956.40.
Studies have suggested worse outcomes in transfused patients and improved outcomes in patients managed with restricted blood transfusion strategies. The authors investigated the relation of blood transfusion to mortality in European intensive care units (ICUs).
The Sepsis Occurrence in Acutely Ill Patients study was a multicenter, observational study that included all adult patients admitted to 198 European ICUs between May 1 and May 15, 2002 and followed them until death, until hospital discharge, or for 60 days. Patients were classified depending on whether they had received a blood transfusion at any time during their ICU stay.
Of 3,147 patients, 1,040 (33.0%) received a blood transfusion. These patients were older (mean age, 62 vs. 60 yr; P = 0.035) and were more likely to have liver cirrhosis or hematologic cancer, to be a surgical admission, and to have sepsis. They had a longer duration of ICU stay (5.9 vs. 2.5 days; P < 0.001) and a higher ICU mortality rate (23.0 vs. 16.3%; P < 0.001) but were also more severely ill on admission (Simplified Acute Physiology Score II, 40.2 vs. 34.7; P < 0.001; Sequential Organ Failure Assessment score, 6.5 vs. 4.5; P < 0.001). There was a direct relation between the number of blood transfusions and the mortality rate, but in multivariate analysis, blood transfusion was not significantly associated with a worse mortality rate. Moreover, in 821 pairs matched according to a propensity score, there was a higher 30-day survival rate in the transfusion group than in the other patients (P = 0.004).
This observational study does not support the view that blood transfusions are associated with increased mortality rates in acutely ill patients.
研究表明，接受输血的患者预后较差，而采用限制性输血策略管理的患者预后较好。作者调查了欧洲重症监护病房（ICU）中输血与死亡率之间的关系。
“急性病患者脓毒症发生率”研究是一项多中心观察性研究，纳入了2002年5月1日至5月15日期间入住198个欧洲ICU的所有成年患者，并对他们进行随访直至死亡、出院或60天。根据患者在ICU住院期间是否接受过输血进行分类。
在3147例患者中，1040例（33.0%）接受了输血。这些患者年龄较大（平均年龄62岁对60岁；P = 0.035），更有可能患有肝硬化或血液系统癌症，因手术入院，且患有脓毒症。他们的ICU住院时间更长（5.9天对2.5天；P < 0.001），ICU死亡率更高（23.0%对16.3%；P < 0.001），但入院时病情也更严重（简化急性生理学评分II，40.2对34.7；P < 0.001；序贯器官衰竭评估评分，6.5对4.5；P < 0.001）。输血次数与死亡率之间存在直接关系，但在多变量分析中，输血与更高的死亡率并无显著关联。此外，在根据倾向评分匹配的821对患者中，输血组的30天生存率高于其他患者（P = 0.004）。
这项观察性研究不支持输血与急性病患者死亡率增加相关的观点。
