Kaukonen Kirsi-Maija, Vaara Suvi T, Pettilä Ville, Bellomo Rinaldo, Tuimala Jarno, Cooper David J, Krusius Tom, Kuitunen Anne, Reinikainen Matti, Koskenkari Juha, Uusaro Ari
Crit Care. 2013 Oct 4;17(5):R222. doi: 10.1186/cc13045.
Transfusion of red blood cells (RBCs) and, in particular, older RBCs has been associated with increased short-term mortality in critically ill patients. We evaluated the association between age of transfused RBCs and acute kidney injury (AKI), hospital, and 90-day mortality in critically ill patients.
We conducted a prospective, observational, predefined sub-study within the FINNish Acute Kidney Injury (FINNAKI) study. This study included all elective ICU admissions with expected ICU stay of more than 24 hours and all emergency admissions from September to November 2011. To study the age of RBCs, we classified transfused patients into quartiles according to the age of oldest transfused RBC unit in the ICU. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria.
Out of 1798 patients, 652 received at least one RBC unit. The median [interquartile range] age of the oldest RBC unit transfused was 12 [11-13] days in the freshest quartile and 21 [17-27] days in the quartiles 2 to 4. On logistic regression, RBC age was not associated with the development of KDIGO stage 3 AKI. Patients in the quartile of freshest RBCs had lower crude hospital and 90-day mortality rates compared to those in the quartiles of older blood. After adjustments, older RBC age was associated with significantly increased risk for hospital mortality. Age, Simplified Acute Physiology Score II (SAPS II)-score without age points, maximum Sequental Organ Failure Assessment (SOFA) score and the total number of transfused RBC units were independently associated with 90-day mortality.
The age of transfused RBC units was independently associated with hospital mortality but not with 90-day mortality or KDIGO stage 3 AKI. The number of transfused RBC units was an independent risk factor for 90-day mortality.
输注红细胞（RBC），尤其是较陈旧的红细胞，与危重症患者短期死亡率增加有关。我们评估了输注红细胞的年龄与危重症患者急性肾损伤（AKI）、住院及90天死亡率之间的关联。
我们在芬兰急性肾损伤（FINNAKI）研究中进行了一项前瞻性、观察性、预先定义的子研究。该研究纳入了所有预计在重症监护病房（ICU）停留超过24小时的择期入院患者以及2011年9月至11月期间的所有急诊入院患者。为研究红细胞的年龄，我们根据ICU中输注的最陈旧红细胞单位的年龄将输注患者分为四分位数。AKI根据KDIGO（改善全球肾脏病预后）标准定义。
在1798例患者中，652例接受了至少一个红细胞单位。在最新鲜的四分位数中，输注的最陈旧红细胞单位的中位[四分位间距]年龄为12[11 - 13]天，在第2至4四分位数中为21[17 - 27]天。在逻辑回归分析中，红细胞年龄与KDIGO 3期AKI的发生无关。与输注较陈旧血液的四分位数患者相比，最新鲜红细胞四分位数的患者粗住院率和90天死亡率较低。调整后，较陈旧的红细胞年龄与住院死亡率显著增加的风险相关。年龄、无年龄点的简化急性生理学评分II（SAPS II）、最高序贯器官衰竭评估（SOFA）评分以及输注的红细胞单位总数与90天死亡率独立相关。
输注红细胞单位的年龄与住院死亡率独立相关，但与90天死亡率或KDIGO 3期AKI无关。输注的红细胞单位数量是90天死亡率 的独立危险因素。
