Koch Colleen Gorman, Li Liang, Sessler Daniel I, Figueroa Priscilla, Hoeltge Gerald A, Mihaljevic Tomislav, Blackstone Eugene H
Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
N Engl J Med. 2008 Mar 20;358(12):1229-39. doi: 10.1056/NEJMoa070403.
Stored red cells undergo progressive structural and functional changes over time. We tested the hypothesis that serious complications and mortality after cardiac surgery are increased when transfused red cells are stored for more than 2 weeks.
We examined data from patients given red-cell transfusions during coronary-artery bypass grafting, heart-valve surgery, or both between June 30, 1998, and January 30, 2006. A total of 2872 patients received 8802 units of blood that had been stored for 14 days or less ("newer blood"), and 3130 patients received 10,782 units of blood that had been stored for more than 14 days ("older blood"). Multivariable logistic regression with propensity-score methods was used to examine the effect of the duration of storage on outcomes. Survival was estimated by the Kaplan-Meier method and Blackstone's decomposition method.
The median duration of storage was 11 days for newer blood and 20 days for older blood. Patients who were given older units had higher rates of in-hospital mortality (2.8% vs. 1.7%, P=0.004), intubation beyond 72 hours (9.7% vs. 5.6%, P<0.001), renal failure (2.7% vs. 1.6%, P=0.003), and sepsis or septicemia (4.0% vs. 2.8%, P=0.01). A composite of complications was more common in patients given older blood (25.9% vs. 22.4%, P=0.001). Similarly, older blood was associated with an increase in the risk-adjusted rate of the composite outcome (P=0.03). At 1 year, mortality was significantly less in patients given newer blood (7.4% vs. 11.0%, P<0.001).
In patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.
储存的红细胞会随着时间推移发生渐进性的结构和功能变化。我们检验了这样一个假设：当输注储存超过2周的红细胞时，心脏手术后严重并发症和死亡率会增加。
我们研究了1998年6月30日至2006年1月30日期间在冠状动脉搭桥术、心脏瓣膜手术或两者皆有的手术中接受红细胞输注的患者数据。共有2872例患者接受了8802单位储存14天或更短时间的血液（“较新鲜血液”），3130例患者接受了10782单位储存超过14天的血液（“较陈旧血液”）。采用倾向评分法的多变量逻辑回归分析来研究储存时间对结局的影响。采用Kaplan-Meier法和布莱克斯通分解法估计生存率。
较新鲜血液的中位储存时间为11天，较陈旧血液为20天。接受较陈旧单位血液的患者住院死亡率更高（2.8%对1.7%，P=0.004），72小时以上插管率更高（9.7%对5.6%，P<0.001），肾衰竭发生率更高（2.7%对1.6%，P=0.003），败血症或脓毒血症发生率更高（4.0%对2.8%，P=0.01）。接受较陈旧血液的患者并发症综合发生率更高（25.9%对22.4%，P=0.001）。同样，较陈旧血液与复合结局的风险调整率增加相关（P=0.03）。1年时，接受较新鲜血液的患者死亡率显著更低（7.4%对11.0%，P<0.001）。
在接受心脏手术的患者中，输注储存超过2周的红细胞与术后并发症风险显著增加以及短期和长期生存率降低相关。
