通用储存前白细胞去除血液成分的介绍，以及在接受输血的心脏手术患者中的结果。
Introduction of universal prestorage leukodepletion of blood components, and outcomes in transfused cardiac surgery patients.
机构信息
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Research and Development, Australian Red Cross Blood Service, Melbourne, Victoria, Australia; Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
出版信息
J Thorac Cardiovasc Surg. 2015 Jul;150(1):216-22. doi: 10.1016/j.jtcvs.2015.03.015. Epub 2015 Mar 14.
OBJECTIVE
To assess whether introduction of universal leukodepletion (ULD) of red blood cells (RBCs) for transfusion was associated with improvements in cardiac surgery patient outcomes.
METHODS
Retrospective study (2005-2010) conducted at 6 institutions. Associations between leukodepletion and outcomes of mortality, infection, and acute kidney injury (AKI) were modeled by logistic regression, and intensive care unit length of stay (LOS) in survivors was explored using linear regression. To examine trends over time, odds ratios (ORs) for outcomes of transfused were compared with nontransfused patients, including a comparison with nontransfused patients who were selected based on propensity score for RBC transfusion.
RESULTS
We studied 14,980 patients, of whom 8857 (59%) had surgery pre-ULD. Transfusions of RBCs were made in 3799 (43%) pre-ULD, and 2525 (41%) post-ULD. Administration of exclusively leukodepleted, versus exclusively nonleukodepleted, RBCs was associated with lower incidence of AKI (adjusted OR 0.80, 95% confidence interval [CI] 0.65-0.98, P = .035), but no difference in mortality or infection. For post-ULD patients, no difference was found in mortality (OR 0.96, 95% CI 0.76-1.22, P = .76) or infection (OR 0.91, 95% CI 0.79-1.03, P = .161); however, AKI was reduced (OR 0.79 95% CI 0.68-0.92, P = .003). However, ORs for post-ULD outcomes were not significantly different in nontransfused, versus transfused, patients. Furthermore, those who received exclusively nonleukodepleted RBCs were more likely to have surgery post-ULD.
CONCLUSIONS
Universal leukodepletion was not associated with reduced mortality or infection in transfused cardiac surgery patients. An association was found between ULD and reduced AKI; however, this reduction was not significantly different from that seen in nontransfused patients, and other changes in care most likely explain such changes in renal outcomes.
目的
评估在心脏手术患者中引入通用去白细胞（ULD）输血是否与改善结局相关。
方法
在 6 家机构进行回顾性研究（2005-2010 年）。通过逻辑回归模型对去白细胞与死亡率、感染和急性肾损伤（AKI）的关系进行建模，并使用线性回归模型探索幸存者重症监护病房（ICU）住院时间（LOS）。为了检验时间趋势，将接受输血的患者的结果与未接受输血的患者进行比较，包括与基于 RBC 输血倾向评分选择的未接受输血的患者进行比较。
结果
我们研究了 14980 名患者，其中 8857 名（59%）在 ULD 前接受了手术。在 ULD 前，3799 名（43%）患者接受了 RBC 输血，2525 名（41%）患者接受了 ULD 后输血。输注专门去白细胞的 RBC 与 AKI 的发生率较低相关（校正比值比 [OR] 0.80，95%置信区间 [CI] 0.65-0.98，P =.035），但死亡率或感染无差异。对于 ULD 后患者，死亡率（OR 0.96，95%CI 0.76-1.22，P =.76）或感染（OR 0.91，95%CI 0.79-1.03，P =.161）无差异；然而，AKI 降低（OR 0.79 95%CI 0.68-0.92，P =.003）。然而，ULD 后患者的输血和非输血患者的 OR 没有显著差异。此外，那些接受专门非去白细胞 RBC 的患者更有可能在 ULD 后接受手术。
结论
通用去白细胞输血与心脏手术患者的死亡率或感染降低无关。ULD 与 AKI 降低相关，但与非输血患者的差异无统计学意义，其他治疗变化可能解释了肾结局的变化。
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