Rocco José Rodolfo, Soares Márcio, Espinoza Rodolfo Andrade
Hospital Universitário Clementino Fraga Filho, UFRJ.
Hospital I do Instituto Nacional de Câncer.
Rev Bras Ter Intensiva. 2006 Sep;18(3):242-50.
Packed red blood cell (PRBC) transfusion is frequent in intensive care unit (ICU). However, the consequences of anemia in ICU patients are poorly understood. Our aim was to evaluate the prevalence, indications, pre-transfusion hematocrit and hemoglobin levels, and outcomes of ICU patients transfused with PRBC.
Prospective cohort study conducted at a medical-surgical ICU of a teaching hospital during a 16-month period. Patients' demographic, clinical, laboratory and transfusion-related data were collected. Logistic regression was used after univariate analyses.
A total of 698 patients were evaluated and 244 (35%) received PRBC, mainly within the first four days of ICU (82.4%). Transfusion was more frequent in medical and emergency surgical patients. The mean pre-transfusion hematocrit and hemoglobin were 22.8% ± 4.5% and 7.9 ± 1.4 g/dL, respectively. Transfused patients received 4.4 ± 3.7 PRBC during ICU stay and 2.2 ± 1 PRBC at each transfusion. The ICU (39.8% versus 13.2%; p < 0.0001) and hospital (48.8% versus 20.3%; p < 0.0001) mortality rates were higher in transfused patients. Mortality increased as the number of transfused PRBC increased (R² = 0.91). In logistic regression, predictive factors for PRBC transfusion were hepatic cirrhosis, mechanical ventilation (MV), type and duration of ICU admission, and hematocrit. The independent factors associated to hospital mortality were MV, transfusions of more than five PRBC and SAPS II score.
PRBC transfusions are frequent in ICU patients, especially in those with medical and emergency surgical complications, longer ICU stay, and hepatic cirrhosis and in need of MV. Pre-transfusion hemoglobin levels were lower than those previously reported. In our study, PRBC transfusion was associated with increased mortality.
在重症监护病房（ICU），浓缩红细胞（PRBC）输血很常见。然而，ICU患者贫血的后果却知之甚少。我们的目的是评估接受PRBC输血的ICU患者的患病率、输血指征、输血前血细胞比容和血红蛋白水平以及预后。
在一家教学医院的内科-外科ICU进行了为期16个月的前瞻性队列研究。收集了患者的人口统计学、临床、实验室和输血相关数据。单因素分析后采用逻辑回归。
共评估了698例患者，其中244例（35%）接受了PRBC输血，主要在入住ICU的前四天内（82.4%）。内科和急诊外科患者输血更为频繁。输血前平均血细胞比容和血红蛋白分别为22.8%±4.5%和7.9±1.4 g/dL。输血患者在ICU住院期间接受了4.4±3.7个PRBC单位，每次输血接受2.2±1个PRBC单位。输血患者的ICU死亡率（39.8%对13.2%；p<0.0001）和医院死亡率（48.8%对20.3%；p<0.0001）更高。死亡率随着PRBC输血量的增加而升高（R²=0.91）。在逻辑回归中，PRBC输血的预测因素为肝硬化、机械通气（MV）、ICU入院类型和持续时间以及血细胞比容。与医院死亡率相关的独立因素为MV、输血量超过5个PRBC单位和急性生理与慢性健康状况评分系统II（SAPS II）评分。
ICU患者PRBC输血很常见，尤其是那些有内科和急诊外科并发症、ICU住院时间较长、患有肝硬化且需要MV的患者。输血前血红蛋白水平低于先前报道。在我们的研究中，PRBC输血与死亡率增加相关。
