Mahambrey Tushar D, Fowler Robert A, Pinto Ruxandra, Smith Terry S, Callum Jeannie L, Pisani Nagib S, Rizoli Sandro B, Adhikari Neill K J
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2009 Oct;56(10):740-50. doi: 10.1007/s12630-009-9151-5. Epub 2009 Jul 30.
To determine associations between red blood cell (RBC) transfusion and early and late clinical outcomes in massively transfused adult trauma patients.
A retrospective cohort study (1992-2001) including 260 patients receiving >or=10 RBC units <or=24 hr after admission to a university-affiliated trauma centre. We extracted demographic and clinical data and used multivariable regression to determine independent effects of RBC transfusion on clinical outcomes.
Patients had a high (mean [standard deviation]) injury severity score (ISS) (42.5 [15.1]), a high admission sequential organ failure assessment (SOFA) score (8.4 [3.8]), and a high hospital mortality (58.5%). They received 38 (25-64) (median [interquartile range]) blood components within 48 hr, including 19 (14-28) RBC units. For 143 patients surviving >or=48 hr, the maximum SOFA score was associated with RBC units transfused before 48 hr (linear regression beta coefficient 0.075, P < 0.0001), lower nadir hemoglobin before 48 hr (0.034, P = 0.03), age (0.032, P = 0.015), and admission SOFA (0.59, P < 0.0001). The RBC units transfused by 48 hr were not associated with either hospital mortality (n = 35) among patients surviving >or=48 hr (independent predictors, age [logistic regression odds ratio (OR) 1.06, 95% confidence interval 1.03-1.10], ISS [OR 1.07, 1.02-1.13], and maximum SOFA score [OR 1.56, 1.27-1.93]) or 48-hr mortality (n = 117) (independent predictors, admission SOFA [1.65, 1.45-1.88] and later year of hospital admission [OR 1.15, 1.02-1.29]).
Hospital mortality is high among massively transfused trauma patients. Among early survivors, 48-hr RBC transfusion volume is associated with increased organ dysfunction, but not hospital mortality. Also, it is not associated with 48-hr mortality. Future research should continue to explore methods to improve hemostasis and minimize the need for RBC transfusion.
确定红细胞（RBC）输注与大量输血的成年创伤患者早期和晚期临床结局之间的关联。
一项回顾性队列研究（1992 - 2001年），纳入260例在大学附属医院创伤中心入院后≤24小时内接受≥10个RBC单位输血的患者。我们提取了人口统计学和临床数据，并使用多变量回归来确定RBC输注对临床结局的独立影响。
患者的损伤严重程度评分（ISS）较高（平均[标准差]）（42.5[15.1]），入院序贯器官衰竭评估（SOFA）评分较高（8.4[3.8]），医院死亡率较高（58.5%）。他们在48小时内接受了38（25 - 64）（中位数[四分位间距]）个血液成分，包括19（14 - 28）个RBC单位。对于存活≥48小时的143例患者，最大SOFA评分与48小时前输注的RBC单位数相关（线性回归β系数0.075，P<0.0001），48小时前的最低血红蛋白水平较低（0.034，P = 0.03），年龄（0.032，P = 0.015），以及入院时的SOFA评分（0.59，P<0.0001）。48小时内输注的RBC单位数与存活≥48小时患者的医院死亡率（n = 35）（独立预测因素，年龄[逻辑回归比值比（OR）1.06，95%置信区间1.03 - 1.10]，ISS[OR 1.07，1.02 - 1.13]，以及最大SOFA评分[OR 1.56，1.27 - 1.93]）或48小时死亡率（n = 117）（独立预测因素，入院时的SOFA评分[1.65，1.45 - 1.88]和较晚的入院年份[OR 1.15，1.02 - 1.29]）均无关联。
大量输血的创伤患者医院死亡率较高。在早期幸存者中，48小时RBC输血量与器官功能障碍增加相关，但与医院死亡率无关。此外，它与48小时死亡率也无关。未来的研究应继续探索改善止血和减少RBC输注需求的方法。
