红细胞输注与严重脓毒症和感染性休克患者的死亡率降低相关：一项倾向评分匹配分析*。

Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis*.

机构信息

Division of Infectious Diseases, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.

出版信息

Crit Care Med. 2012 Dec;40(12):3140-5. doi: 10.1097/CCM.0b013e3182657b75.

DOI:10.1097/CCM.0b013e3182657b75

PMID:22975891

Abstract

OBJECTIVES

To evaluate the effects of transfusions in patients with severe sepsis and septic shock on mortality.

DESIGN

Propensity-matched analysis of a prospective observational database (April 2005 to February 2009).

SETTING

Twenty-two medical and surgical intensive care units in 12 teaching hospitals in Korea.

PATIENTS

One thousand fifty-four patients with community-acquired severe sepsis and septic shock.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of the 1,054 patients, 407 (38.6%) received a blood transfusion. The mean pretransfusion hemoglobin level was 7.7 ± 1.2 g/dL. Transfused patients had higher 28-day and in-hospital mortality rates (32.7% vs. 17.3%; p < .001, 41.3% vs. 20.3%; p < .001, respectively) and a longer duration of hospital stay (21 [interquartile range, 10-35] vs. 13 [interquartile range, 8-24] days; p < .001), but were more severely ill at admission (lower systolic blood pressure, higher Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score at admission). In 152 pairs matched according to the propensity score depending on patient transfusion status, transfused patients had a lower risk of 7-day (9.2% vs. 27.0%; p < .001), 28-day (24.3% vs. 38.8%; p = .007), and in-hospital mortality rates (31.6% vs. 42.8%; p = .044). After adjusting for blood transfusion as a time-dependent variable in multivariable analysis, blood transfusion was independently associated with lower risk of 7-day (hazard ratio 0.42, 95% confidence interval 0.19-0.50, p = .026), 28-day (hazard ratio 0.43, 95% confidence interval 0.29-0.62, p < .001), and in-hospital mortality (hazard ratio 0.51, 95% confidence interval 0.39-0.69, p < .001).

CONCLUSIONS

In this observational study of patients with community-acquired severe sepsis and septic shock, red blood cell transfusions were associated with lower risk of mortality.

摘要

目的

评估严重脓毒症和脓毒性休克患者输血对死亡率的影响。

设计

前瞻性观察数据库的倾向性匹配分析（2005 年 4 月至 2009 年 2 月）。

地点

韩国 12 所教学医院的 22 个内科和外科重症监护病房。

患者

1054 例社区获得性严重脓毒症和脓毒性休克患者。

干预措施

无。

测量和主要结果

在 1054 例患者中，407 例（38.6%）接受了输血。输血前平均血红蛋白水平为 7.7 ± 1.2 g/dL。输血患者的 28 天和住院死亡率更高（32.7%比 17.3%；p<0.001，41.3%比 20.3%；p<0.001），住院时间更长（21 [四分位间距，10-35] 比 13 [四分位间距，8-24] 天；p<0.001），但入院时病情更严重（收缩压更低，急性生理学和慢性健康评估 II 评分和序贯器官衰竭评估评分更高）。在根据患者输血状态匹配的 152 对倾向评分中，输血患者的 7 天（9.2%比 27.0%；p<0.001）、28 天（24.3%比 38.8%；p=0.007）和住院死亡率风险较低（31.6%比 42.8%；p=0.044）。在校正输血作为多变量分析中的时间依赖性变量后，输血与 7 天（风险比 0.42，95%置信区间 0.19-0.50，p=0.026）、28 天（风险比 0.43，95%置信区间 0.29-0.62，p<0.001）和住院死亡率（风险比 0.51，95%置信区间 0.39-0.69，p<0.001）风险降低独立相关。