Department of Anesthesiology and Intensive Care, Friedrich Schiller University Hospital, Erlanger Allee 103, Jena 07743, Germany.
Crit Care. 2010;14(3):R92. doi: 10.1186/cc9026. Epub 2010 May 24.
Studies in intensive care unit (ICU) patients have suggested that anemia and blood transfusions can influence outcomes, but these effects have not been widely investigated specifically in surgical ICU patients.
We retrospectively analyzed the prospectively collected data from all adult patients (>18 years old) admitted to a 50-bed surgical ICU between 1st March 2004 and 30th July 2006.
Of the 5925 patients admitted during the study period, 1833 (30.9%) received a blood transfusion in the ICU. Hemoglobin concentrations were < 9 g/dl on at least one occasion in 57.6% of patients. Lower hemoglobin concentrations were associated with a higher Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score, greater mortality rates, and longer ICU and hospital lengths of stay. Transfused patients had higher ICU (12.5 vs. 3.2%) and hospital (18.3 vs. 6.5%) mortality rates (both p < 0.001) than non-transfused patients. However, ICU and in-hospital mortality rates were similar among transfused and non-transfused matched pairs according to a propensity score (n = 1184 pairs), and after adjustment for possible confounders in a multivariable analysis, higher hemoglobin concentrations (RR 0.97[0.95-0.98], per 1 g/dl, p < 0.001) and blood transfusions (RR 0.96[0.92-0.99], p = 0.031) were independently associated with a lower risk of in-hospital death, especially in patients aged from 66 to 80 years, in patients admitted to the ICU after non-cardiovascular surgery, in patients with higher severity scores, and in patients with severe sepsis.
In this group of surgical ICU patients, anemia was common and was associated with higher morbidity and mortality. Higher hemoglobin concentrations and receipt of a blood transfusion were independently associated with a lower risk of in-hospital death. Randomized control studies are warranted to confirm the potential benefit of blood transfusions in these subpopulations.
在重症监护病房（ICU）患者中的研究表明，贫血和输血会影响结果，但这些影响尚未在外科 ICU 患者中得到广泛研究。
我们回顾性分析了 2004 年 3 月 1 日至 2006 年 7 月 30 日期间入住 50 张床位的外科 ICU 的所有成年患者（>18 岁）的前瞻性收集数据。
在研究期间，5925 名患者中，1833 名（30.9%）在 ICU 接受输血。57.6%的患者至少有一次血红蛋白浓度<9 g/dl。较低的血红蛋白浓度与更高的简化急性生理学评分 II 和序贯器官衰竭评估评分、更高的死亡率以及更长的 ICU 和住院时间有关。接受输血的患者 ICU（12.5%比 3.2%）和医院（18.3%比 6.5%）死亡率更高（均<0.001），而非输血患者。然而，根据倾向评分（n=1184 对），在输血和非输血匹配对中，ICU 和住院死亡率相似，并且在多变量分析中调整可能的混杂因素后，较高的血红蛋白浓度（RR 0.97[0.95-0.98]，每 1 g/dl，<0.001）和输血（RR 0.96[0.92-0.99]，p=0.031）与较低的住院死亡率风险独立相关，尤其是 66-80 岁的患者、非心血管手术后入住 ICU 的患者、严重程度评分较高的患者和严重脓毒症患者。
在这组外科 ICU 患者中，贫血很常见，与更高的发病率和死亡率相关。较高的血红蛋白浓度和输血与住院死亡率降低独立相关。需要随机对照研究来证实这些亚人群输血的潜在益处。
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