2011 - 2012年医疗保险数据库记录的美国住院老年患者发热性非溶血性输血反应的发生情况及潜在风险因素。

Febrile non-haemolytic transfusion reaction occurrence and potential risk factors among the U.S. elderly transfused in the inpatient setting, as recorded in Medicare databases during 2011-2012.

作者信息

Menis M, Forshee R A, Anderson S A, McKean S, Gondalia R, Warnock R, Johnson C, Mintz P D, Worrall C M, Kelman J A, Izurieta H S

机构信息

Food and Drug Administration, Silver Spring, MD, USA.

出版信息

Vox Sang. 2015 Apr;108(3):251-61. doi: 10.1111/vox.12215. Epub 2014 Dec 3.

DOI:10.1111/vox.12215

PMID:25470076

Abstract

BACKGROUND AND OBJECTIVES

Febrile non-haemolytic transfusion reaction (FNHTR) is an acute transfusion complication resulting in fever, chills and/or rigours. Study's objective was to assess FNHTR occurrence and potential risk factors among inpatient U.S. elderly Medicare beneficiaries, ages 65 and older, during 2011-2012.

MATERIALS AND METHODS

Our retrospective claims-based study utilized large Medicare administrative databases. FNHTR was ascertained via ICD-9-CM diagnosis code, and transfusions were identified by recorded procedure and revenue centre codes. The study ascertained FNHTR rates among the inpatient elderly overall and by age, gender, race, blood components and units transfused. Multivariate logistic regression analyses were used to assess potential risk factors.

RESULTS

Among 4 336 338 inpatient transfusion stays for elderly during 2011-2012, 2517 had FNHTR diagnosis recorded, an overall rate of 58.0 per 100,000 stays. FNHTR rates (per 100,000 stays) varied by age, gender, number of units and blood components transfused. FNHTR rates were substantially higher for RBCs- and platelets-containing transfusions as compared to plasma only. Significantly higher odds of FNHTR were identified with greater number of units transfused (P < 0.01), for females vs. males (OR = 1.15, 95% CI 1.04-1.27), and with 1-year histories of transfusion (OR = 1.25, 95% CI 1.10-1.42), lymphoma (OR = 1.22, 95% CI 1.02-1.46), leukaemia (OR = 1.90, 95% CI 1.56-2.31) and other diseases.

CONCLUSIONS

Our study shows increased FNHTR occurrence among elderly with greater number of units and with RBCs- and platelets-containing transfusions, suggesting need to evaluate effectiveness of prestorage leucoreduction in elderly. The study also suggests importance of prior recipient alloimmunization and underlying health conditions in the development of FNHTR.

摘要

背景与目的

发热性非溶血性输血反应（FNHTR）是一种急性输血并发症，可导致发热、寒战和/或畏寒。本研究的目的是评估2011 - 2012年期间美国65岁及以上老年医疗保险受益住院患者中FNHTR的发生率及潜在风险因素。

材料与方法

我们基于索赔记录的回顾性研究使用了大型医疗保险管理数据库。通过ICD - 9 - CM诊断代码确定FNHTR，并通过记录的程序和收入中心代码识别输血情况。该研究确定了总体住院老年人以及按年龄、性别、种族、血液成分和输注单位数划分的FNHTR发生率。采用多因素逻辑回归分析评估潜在风险因素。

结果

在2011 - 2012年期间4336338例老年住院输血病例中，有2517例记录了FNHTR诊断，总体发生率为每10万例住院病例58.0例。FNHTR发生率（每10万例住院病例）因年龄、性别、输注单位数和血液成分而异。与仅输注血浆相比，含红细胞和血小板的输血的FNHTR发生率显著更高。输注单位数越多（P < 0.01）、女性相对于男性（OR = 1.15，95% CI 1.04 - 1.27）以及有1年输血史（OR = 1.25，95% CI 1.10 - 1.42）、淋巴瘤（OR = 1.22，95% CI 1.02 - 1.46）、白血病（OR = 1.90，95% CI 1.56 - 2.31）和其他疾病的患者发生FNHTR的几率显著更高。