Department of Anesthesia and Intensive Care, Heart Institute, University of São Paulo, São Paulo, Brazil.
Department of Intensive Care, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium.
J Thorac Cardiovasc Surg. 2015 Nov;150(5):1314-20. doi: 10.1016/j.jtcvs.2015.07.051. Epub 2015 Jul 26.
The aim of this study was to compare outcomes in patients undergoing cardiac surgery who are aged 60 years or more or less than 60 years after implementation of a restrictive or a liberal transfusion strategy.
This is a substudy of the Transfusion Requirements After Cardiac Surgery (TRACS) randomized controlled trial. In this subgroup analysis, we separated patients into those aged 60 years or more (elderly) and those aged less than 60 years randomized to a restrictive or a liberal strategy of red blood cell transfusion. The primary outcome was a composite defined as a combination of 30-day all-cause mortality and severe morbidity.
Of the 502 patients included in the Transfusion Requirements After Cardiac Surgery study, 260 (51.8%) were aged 60 years or more and 242 (48.2%) were aged less than 60 years and were included in this study. The primary end point occurred in 11.9% of patients in the liberal strategy group and 16.8% of patients in the restrictive strategy group (P = .254) for those aged 60 years or more and in 6.8% of patients in the liberal strategy group and 5.6% of patients in the restrictive strategy group for those aged less than 60 years (P = .714). However, in the older patients, cardiogenic shock was more frequent in patients in the restrictive transfusion group (12.8% vs 5.2%, P = .031). Thirty-day mortality, acute respiratory distress syndrome, and acute renal injury were similar in the restrictive and liberal transfusion groups in both age groups.
Although there was no difference between groups regarding the primary outcome, a restrictive transfusion strategy may result in an increased rate of cardiogenic shock in elderly patients undergoing cardiac surgery compared with a more liberal strategy. Cardiovascular risk of anemia may be more harmful than the risk of blood transfusion in older patients.
本研究旨在比较在实施限制性或宽松性输血策略后，年龄在 60 岁及以上或 60 岁以下的心脏手术患者的结局。
这是心脏手术后输血需求（TRACS）随机对照试验的亚组研究。在这项亚组分析中，我们将患者分为年龄在 60 岁及以上（老年）和年龄在 60 岁以下，随机分配到限制性或宽松性红细胞输血策略的患者。主要结局是定义为 30 天全因死亡率和严重发病率的组合。
在接受心脏手术后输血需求研究的 502 名患者中，260 名（51.8%）年龄在 60 岁及以上，242 名（48.2%）年龄在 60 岁以下，被纳入本研究。在年龄在 60 岁及以上的患者中，宽松输血策略组的主要终点发生率为 11.9%，而限制性输血策略组为 16.8%（P=0.254）；在年龄在 60 岁以下的患者中，宽松输血策略组的发生率为 6.8%，而限制性输血策略组的发生率为 5.6%（P=0.714）。然而，在老年患者中，限制性输血组的心源性休克更为常见（12.8%比 5.2%，P=0.031）。在两组年龄组中，限制性和宽松输血组的 30 天死亡率、急性呼吸窘迫综合征和急性肾损伤相似。
尽管两组之间主要结局无差异，但与更宽松的策略相比，限制性输血策略可能导致老年心脏手术患者心源性休克的发生率增加。贫血的心血管风险可能比老年患者输血的风险更有害。
