Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada.
Transfusion. 2010 Sep;50(9):1902-13. doi: 10.1111/j.1537-2995.2010.02661.x.
The objective was to determine if there is an association between red blood cell (RBC) storage time and development of new or progressive multiple organ dysfunction syndrome (MODS) in critically ill children.
This was an analytic cohort analysis of patients enrolled in a randomized controlled trial, TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units; ISRCTN37246456), in which stable critically ill children were randomly assigned to a restrictive or liberal strategy. Transfused patients were analyzed using three different sliding time cutoffs (7, 14, and 21 days). Storage time for multiply transfused patients was defined according to the oldest unit transfused.
A total of 455 patients were retained (liberal, 310; restrictive, 145). Multivariate logistic regression was performed to determine independent associations. In the restrictive group, a maximum RBC storage time of more than 21 days was independently associated with new or progressive MODS (adjusted odds ratio [OR], 3.29; 95% confidence interval [CI], 1.21-9.04). The same association was found in the liberal group for a storage time of more than 14 days (adjusted OR, 2.50; 95% CI, 1.12-5.58). When the two groups were combined in a meta-analysis, a storage time of more than 14 days was independently associated with increased MODS (adjusted OR, 2.23; 95% CI, 1.20-4.15) and more than 21 days was associated with increased Pediatric Logistic Organ Dysfunction (PELOD) scores (adjusted mean difference, 4.26; 95% CI, 1.99-6.53) and higher mortality (9.2% vs. 3.8%).
Stable critically ill children who receive RBC units with storage times longer than 2 to 3 weeks may be at greater risk of developing new or progressive MODS.
本研究旨在确定红细胞（RBC）储存时间与危重症患儿新发或进展性多器官功能障碍综合征（MODS）之间是否存在关联。
这是一项对 TRIPICU（儿科重症监护病房输血需求；ISRCTN37246456）随机对照试验中入组患者进行的分析性队列研究，其中稳定的危重症患儿被随机分配至限制性或宽松性策略组。采用三种不同的滑动时间截止值（7、14 和 21 天）对接受输血的患者进行分析。对于多次输血的患者，根据输注的最陈旧血袋定义储存时间。
共纳入 455 例患者（宽松组 310 例，限制组 145 例）。采用多变量逻辑回归分析确定独立相关性。在限制组中，RBC 储存时间超过 21 天与新发或进展性 MODS 独立相关（校正比值比[OR]，3.29；95%置信区间[CI]，1.21-9.04）。在宽松组中，储存时间超过 14 天也存在相同的相关性（校正 OR，2.50；95% CI，1.12-5.58）。当将两组合并进行荟萃分析时，储存时间超过 14 天与 MODS 增加独立相关（校正 OR，2.23；95% CI，1.20-4.15），超过 21 天与儿科 LOGISTIC 器官功能障碍评分（PELOD）升高（校正平均差，4.26；95% CI，1.99-6.53）和死亡率升高（9.2%比 3.8%）相关。
接受储存时间超过 2 至 3 周的 RBC 单位的稳定危重症患儿可能面临新发或进展性 MODS 的更高风险。
