Bellomo Rinaldo, Mårtensson Johan, Kaukonen Kirsi-Maija, Lo Serigne, Gallagher Martin, Cass Alan, Myburgh John, Finfer Simon
1Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 2Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. 3Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. 4Department of Anaesthesiology, Helsinki University Central Hospital, Helsinki, Finland. 5Department of Nephrology, The George Institute for Global Health, University of Sydney, Sydney, Australia.
Crit Care Med. 2016 May;44(5):892-900. doi: 10.1097/CCM.0000000000001518.
To assess the epidemiology and outcomes associated with RBC transfusion in patients with severe acute kidney injury requiring continuous renal replacement therapy.
Post hoc analysis of data from a multicenter, randomized, controlled trial.
Thirty-five ICUs in Australia and New Zealand.
Cohort of 1,465 patients enrolled in the Randomized Evaluation of Normal versus Augmented Level replacement therapy study.
Daily information on morning hemoglobin level and amount of RBC transfused were prospectively collected in the Randomized Evaluation of Normal versus Augmented Level study. We analyzed the epidemiology of such transfusions and their association with clinical outcomes.
Overall, 977 patients(66.7%) received a total of 1,192 RBC units. By day 5, 785 of 977 transfused patients (80.4%) had received at least one RBC transfusion. Hemoglobin at randomization was lower in transfused than in nontransfused patients (94 vs 111 g/L; p < 0.001). Mean daily hemoglobin was 88 ± 7 and 99 ± 12 g/L in transfused and nontransfused patients. Among transfused patients, 228 (46.7%) had died by day 90 when compared with 426 (43.6%) of nontransfused patients (p = 0.27). Survivors received on average 316 ± 261 mL of RBC, whereas nonsurvivors received 302 ± 362 mL (p = 0.42). On multivariate Cox regression analysis, RBC transfusion was independently associated with lower 90-day mortality (hazard ratio, 0.55; 95% CI, 0.38-0.79). However, we found no independent association between RBC transfusions and mortality when the analyses were restricted to patients surviving at least 5 days (hazard ratio, 1.29; 95% CI, 0.90-1.85). We found no independent association between RBC transfusion and renal replacement therapy-free days, mechanical ventilator-free days, or length of stay in ICU or hospital.
In patients with severe acute kidney injury treated with continuous renal replacement therapy, we found no association of RBC transfusion with 90-day mortality or other patient-centered outcomes. The optimal hemoglobin threshold for RBC transfusion in such patients needs to be determined in future randomized controlled trials.
评估需要持续肾脏替代治疗的严重急性肾损伤患者红细胞输注的流行病学情况及相关结局。
对一项多中心、随机、对照试验的数据进行事后分析。
澳大利亚和新西兰的35个重症监护病房。
纳入“正常水平与强化水平替代治疗随机评估”研究的1465例患者队列。
在“正常水平与强化水平随机评估”研究中前瞻性收集每日早晨血红蛋白水平和红细胞输注量的信息。我们分析了此类输血的流行病学情况及其与临床结局的关联。
总体而言，977例患者（66.7%）共接受了1192个红细胞单位的输注。到第5天，977例接受输血的患者中有785例（80.4%）至少接受了一次红细胞输注。随机分组时，接受输血患者的血红蛋白水平低于未输血患者（94 vs 111 g/L；p<0.001）。接受输血和未输血患者的平均每日血红蛋白水平分别为88±7 g/L和99±12 g/L。在接受输血的患者中，到第90天时228例（46.7%）死亡，而未输血患者中有426例（43.6%）死亡（p = 0.27）。幸存者平均接受了316±261 mL的红细胞输注，而非幸存者接受了302±362 mL（p = 0.42）。多因素Cox回归分析显示，红细胞输注与90天较低的死亡率独立相关（风险比，0.55；95%CI，0.38 - 0.79）。然而，当分析仅限于至少存活5天的患者时，我们发现红细胞输注与死亡率之间无独立关联（风险比，1.29；95%CI，0.90 - 1.85）。我们发现红细胞输注与无肾脏替代治疗天数、无机械通气天数或重症监护病房或医院住院时间之间无独立关联。
在接受持续肾脏替代治疗的严重急性肾损伤患者中，我们发现红细胞输注与90天死亡率或其他以患者为中心的结局无关。此类患者红细胞输注的最佳血红蛋白阈值有待未来的随机对照试验确定。
