Inaba Kenji, Branco Bernardino C, Rhee Peter, Blackbourne Lorne H, Holcomb John B, Spinella Philip C, Shulman Ira, Nelson Janice, Demetriades Demetrios
Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California 90033-4525, USA.
J Trauma. 2011 Dec;71(6):1766-73; discussion 1773-4. doi: 10.1097/TA.0b013e31823bdbf9.
There is increasing evidence that the duration of red blood cell (RBC) storage negatively impacts outcomes. Data regarding prolonged storage of other blood components, however, are lacking. The aim of this study was to evaluate how the duration of platelet storage affects trauma patient outcomes.
Trauma patients admitted to a Level I trauma center requiring platelet transfusion (2006-2009) were retrospectively identified. Apheresis platelets (aPLT) containing ≥3 × 10(11) platelets/unit were used exclusively. Patients were analyzed in three groups: those who received only aPLT stored for ≤3 days, 4 days, and 5 days. The outcomes included mortality and complications (sepsis, acute respiratory distress syndrome, renal, and liver failure).
Three hundred eighty-one patients were available for analysis (128 received aPLT ≤3 days old; 109 = 4 days old; and 144 = 5 days old). There were no significant demographic differences between groups. Patients receiving aPLT aged = 4 days had significantly higher Injury Severity Score (p = 0.022) and were more likely to have a head Abbreviated Injury Scale ≥3 (p = 0.014). There were no differences in volumes transfused or age of RBC, plasma, cryoprecipitate, or factor VIIa. After adjusting for confounders, exposure to older aPLT did not impact mortality; however, with increasing age, complications were significantly higher. The rate of sepsis, in particular, was significantly increased (5.5% for aPLT ≤3 days vs. 9.2% for aPLT = 4 days vs. 16.7% for aPLT = 5 days, adjusted p = 0.033). For acute respiratory distress syndrome and renal and liver failure, similar trends were observed.
In critically ill trauma patients, there was a stepwise increase in complications, in particular sepsis, with exposure to progressively older platelets. Further evaluation of the underlying mechanism and methods for minimizing exposure to older platelets is warranted.
越来越多的证据表明，红细胞（RBC）储存时间会对治疗结果产生负面影响。然而，关于其他血液成分长时间储存的数据却很缺乏。本研究的目的是评估血小板储存时间如何影响创伤患者的治疗结果。
回顾性确定2006年至2009年入住一级创伤中心且需要输注血小板的创伤患者。仅使用每单位含有≥3×10¹¹个血小板的单采血小板（aPLT）。患者被分为三组进行分析：仅接受储存时间≤3天、4天和5天的aPLT的患者。治疗结果包括死亡率和并发症（脓毒症、急性呼吸窘迫综合征、肾衰竭和肝衰竭）。
381例患者可供分析（128例接受≤3天龄的aPLT；109例接受4天龄的aPLT；144例接受5天龄的aPLT）。各组之间在人口统计学方面无显著差异。接受4天龄aPLT的患者损伤严重程度评分显著更高（p = 0.022），且更有可能头部简明损伤定级标准≥3分（p = 0.014）。在输注量或红细胞、血浆、冷沉淀或凝血因子VIIa的年龄方面无差异。在对混杂因素进行校正后，使用较老龄aPLT并不影响死亡率；然而，随着年龄增长，并发症显著增多。特别是脓毒症发生率显著升高（储存≤3天的aPLT为5.5%，4天龄的aPLT为9.2%，5天龄的aPLT为16.7%，校正p = 0.033）。对于急性呼吸窘迫综合征以及肾衰竭和肝衰竭，观察到类似趋势。
在重症创伤患者中，随着接触的血小板年龄逐渐增大，并发症尤其是脓毒症呈逐步增加趋势。有必要进一步评估其潜在机制以及尽量减少接触老龄血小板的方法。
