Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, Australia.
School of Medicine, The University of Queensland, Herston, Brisbane, QLD, Australia.
Intensive Care Med. 2015 Dec;41(12):2087-97. doi: 10.1007/s00134-015-4078-5. Epub 2015 Oct 5.
There is substantial conjecture regarding the clinical significance of packed red blood cell (PRBC) changes that occur during in vitro storage. Here, we present a meta- and systematic analysis of adult studies published between 1994 and 2015 with the aim of updating existing quantitative reviews and providing a comprehensive cover of the six most commonly studied outcomes-mortality, infection, renal dysfunction, multiple organ dysfunction syndrome (MODS), thrombotic complications and prolonged hospital length of stay.
Computerised searches of Pubmed and EMBASE identified publications that reported target outcomes and PRBC storage duration prior to transfusion. Bibliographies of relevant literature were manually searched to incorporate missed studies. Randomised controlled trial (RCT) data was meta-analysed using a random effects model with Cochrane Collaboration Review Manager (RevMan) version 5.1 software. Observational investigations were systematically reviewed.
Sixty-four papers were selected covering 462,581 patients with the majority of studies being observational in nature. Meta-analysis of eight RCTs demonstrated a trend towards decreased mortality with stored PRBC transfusion; albeit this effect was not statistically significant (OR 0.91, 95 % CI 0.78-1.05, p = 0.20). In a small subset of intensive care unit (ICU), cardiac surgery and trauma patients; observational studies suggested that prolonged storage may be correlated with increased mortality. Trauma and cardiac surgery patients appeared to be most susceptible to the potential infectious complications of stored PRBCs. Stored PRBCs were unlikely to affect thrombotic complications or hospital length of stay. There were inadequate data to determine whether stored PRBCs had clinically relevant effects on renal dysfunction and MODS.
Although literature presents a concerning picture of potential storage complications, current findings are too inconsistent to drive changes in clinical practice. Results from current RCTs will likely play a role in PRBC age guidelines for cardiac surgery and ICU patients. However, these studies may be less efficacious at detecting small effects that are limited to specific subpopulations.
在体外储存过程中，关于红细胞压积（PRBC）变化的临床意义存在大量推测。在这里，我们对 1994 年至 2015 年间发表的成人研究进行了荟萃分析和系统分析，旨在更新现有的定量综述，并全面涵盖最常研究的六个结果 - 死亡率，感染，肾功能障碍，多器官功能障碍综合征（MODS），血栓并发症和延长住院时间。
计算机检索 Pubmed 和 EMBASE 以确定报告目标结果和输血前 PRBC 储存时间的出版物。手动搜索相关文献的参考文献以纳入遗漏的研究。使用随机效应模型和 Cochrane 协作评论经理（RevMan）版本 5.1 软件对随机对照试验（RCT）数据进行荟萃分析。对观察性研究进行系统评价。
选择了 64 篇论文，涵盖了 462,581 名患者，其中大多数研究为观察性研究。对八项 RCT 的荟萃分析表明，储存的 PRBC 输血后死亡率呈下降趋势; 尽管这种效果没有统计学意义（OR 0.91，95％CI 0.78-1.05，p = 0.20）。在一小部分重症监护病房（ICU），心脏手术和创伤患者中; 观察性研究表明，长时间储存可能与死亡率增加有关。创伤和心脏手术患者似乎最容易受到储存 PRBC 的潜在感染并发症的影响。储存的 PRBC 不太可能影响血栓并发症或住院时间。没有足够的数据来确定储存的 PRBC 是否对肾功能障碍和 MODS 有临床相关影响。
尽管文献提出了潜在储存并发症的令人担忧的情况，但目前的发现太不一致，无法改变临床实践。当前 RCT 的结果可能会在心脏手术和 ICU 患者的 PRBC 年龄指南中发挥作用。然而，这些研究可能在检测仅限于特定亚人群的小效应方面效果较差。
