与退伍军人事务部重症监护病房输血实践相关的患者因素：对进一步研究的启示。

Patient factors associated with transfusion practices in Veterans Affairs intensive care units: implications for further research.

机构信息

Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital (152), Bedford, MA 01730, USA.

出版信息

J Crit Care. 2011 Aug;26(4):431.e1-9. doi: 10.1016/j.jcrc.2010.12.012. Epub 2011 Mar 3.

DOI:10.1016/j.jcrc.2010.12.012

PMID:21376514

Abstract

PURPOSE

We sought to describe how patient characteristics influence the frequency of red blood cell (RBC) transfusions among critically ill patients after taking into account hemoglobin (Hgb) level.

METHODS

This was a retrospective cohort study using secondary analysis of administrative data of Veterans Affairs intensive care unit (ICU) admissions. The outcome of interest was RBC transfusion during the first 30 days of ICU admission. Besides Hgb level, explanatory variables included demographics, admission-related information, comorbid conditions, ICU admission diagnosis, and selected laboratory test results. Logistic regression modeling quantified associations between explanatory variables and transfusion.

RESULTS

For 259 281 ICU admissions from 2001 to 2005, the overall incidence of RBC transfusion was 12.5%. Increased age, male gender, admission for acute myocardial infarction (AMI), and comorbid heart disease were independently associated with transfusion. Compared with admission for reference diagnoses, transfusions were more likely for admissions for AMI, unstable angina, and congestive heart failure only at Hgb levels below 11, 9, and 6 g/dL, respectively.

CONCLUSIONS

Intensive care unit patients admitted for AMI, unstable angina, and congestive heart-failure had higher likelihood of receiving RBC transfusions below specific Hgb levels varying from 6 to 11 g/dL. Further research is needed to determine how these transfusion practices influence outcomes.

摘要

目的

本研究旨在描述考虑血红蛋白（Hgb）水平后，患者特征如何影响危重症患者的红细胞（RBC）输注频率。

方法

这是一项回顾性队列研究，使用退伍军人事务部重症监护病房（ICU）入院的行政数据进行二次分析。主要结局是 ICU 入院后 30 天内的 RBC 输注。除 Hgb 水平外，解释变量还包括人口统计学、入院相关信息、合并症、ICU 入院诊断和选定的实验室检查结果。逻辑回归模型量化了解释变量与输血之间的关联。

结果

在 2001 年至 2005 年期间，259281 例 ICU 入院患者中，输血的总体发生率为 12.5%。年龄增长、男性、急性心肌梗死（AMI）入院和合并心脏病与输血独立相关。与参考诊断入院相比，仅在 Hgb 水平低于 11、9 和 6 g/dL 时，AMI、不稳定型心绞痛和充血性心力衰竭的入院与输血更相关。