低网织红细胞血红蛋白含量与危重症患者更高的输血率相关：一项队列研究。

Low reticulocyte hemoglobin content is associated with a higher blood transfusion rate in critically ill patients: a cohort study.

机构信息

Intensive Care Unit, Hospital Sant Joan de Deu-Fundació Althaia, CIBER Enfermedades Respiratorias, Manresa, Spain.

出版信息

Anesthesiology. 2010 May;112(5):1211-5. doi: 10.1097/ALN.0b013e3181d74f87.

DOI:10.1097/ALN.0b013e3181d74f87

PMID:20418700

Abstract

BACKGROUND

Intensive care unit (ICU) patients often need blood transfusion, but no reliable predictors of transfusion requirements are available at ICU admission. The authors hypothesized that ICU patients with functional iron deficiency may be at higher risk for developing anemia, requiring blood transfusion. Their objective was to determine whether low reticulocyte hemoglobin content (CHr) was associated with transfusion requirements in ICU patients.

METHODS

This is a prospective cohort study in a general ICU. The authors studied 62 patients, after excluding those transfused on or before ICU admission. The authors recorded age, diagnosis, severity score, presence of sepsis, ICU complications, ICU treatments, and transfusion-free interval. Threshold for low CHr was 29 pg. The authors also recorded ICU and hospital outcome. The statistical analysis included Cox proportional hazard function for transfusion.

RESULTS

Twenty-three patients (37%) presented with low CHr on ICU admission and tended to be sicker and more likely to have sepsis than those with normal CHr. They were also more prone to complications, particularly acute renal failure (39 vs. 13% P = 0.02) and ICU-acquired infection (30 vs. 10% P = 0.04). The overall transfusion rate was 22.6%, being higher in low-CHr patients than in normal-CHr patients (39.1 vs. 12.8%, P = 0.02). After adjusting for severity of illness, age, trauma, and hemoglobin level, low CHr remained significantly associated with transfusion, with a hazard ratio of 3.6 (95% CI, 1.2-10.7; P = 0.02). Median ICU stay was also longer in patients with low CHr (8 vs. 5 days, P = 0.01). Differences in mortality did not reach statistical significance.

CONCLUSION

Low CHr is common at ICU admission and is associated with higher transfusion requirements.

摘要

背景

重症监护病房（ICU）患者经常需要输血，但在 ICU 入院时没有可靠的输血需求预测指标。作者假设 ICU 中存在功能性缺铁的患者可能面临更高的贫血风险，需要输血。他们的目的是确定低网织红细胞血红蛋白含量（CHr）是否与 ICU 患者的输血需求相关。

方法

这是一项在普通 ICU 中进行的前瞻性队列研究。作者排除了在 ICU 入院前或入院当天输血的患者后，共研究了 62 名患者。作者记录了年龄、诊断、严重程度评分、是否存在脓毒症、ICU 并发症、ICU 治疗和无输血间隔。低 CHr 的阈值为 29pg。作者还记录了 ICU 和医院的转归。统计分析包括输血的 Cox 比例风险函数。

结果

23 名患者（37%）在 ICU 入院时存在低 CHr，与 CHr 正常的患者相比，他们的病情更严重，更有可能患有脓毒症。他们也更容易发生并发症，特别是急性肾功能衰竭（39%比 13%，P=0.02）和 ICU 获得性感染（30%比 10%，P=0.04）。总的输血率为 22.6%，低 CHr 患者的输血率高于 CHr 正常的患者（39.1%比 12.8%，P=0.02）。在调整了疾病严重程度、年龄、创伤和血红蛋白水平后，低 CHr 与输血仍显著相关，风险比为 3.6（95%CI，1.2-10.7；P=0.02）。低 CHr 患者的 ICU 住院时间也更长（中位数为 8 天比 5 天，P=0.01）。死亡率的差异没有达到统计学意义。