Edgren Gustaf, Ullum Henrik, Rostgaard Klaus, Erikstrup Christian, Sartipy Ulrik, Holzmann Martin J, Nyrén Olof, Hjalgrim Henrik
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Immunology, the Blood Bank, Rigshospitalet, Copenhagen, Denmark.
JAMA Intern Med. 2017 Jun 1;177(6):854-860. doi: 10.1001/jamainternmed.2017.0890.
Following animal model data indicating the possible rejuvenating effects of blood from young donors, there have been at least 2 observational studies conducted with humans that have investigated whether donor age affects patient outcomes. Results, however, have been conflicting.
To study the association of donor age and sex with survival of patients receiving transfusions.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study based on the Scandinavian Donations and Transfusions database, with nationwide data, was conducted for all patients from Sweden and Denmark who received at least 1 red blood cell transfusion of autologous blood or blood from unknown donors between January 1, 2003, and December 31, 2012. Patients were followed up from the first transfusion until death, emigration, or end of follow-up. Data analysis was performed from September 15 to November 15, 2016.
The number of transfusions from blood donors of different age and sex. Exposure was treated time dependently throughout follow-up.
Hazard ratios (HRs) for death and adjusted cumulative mortality differences, both estimated using Cox proportional hazards regression.
Results of a crude analysis including 968 264 transfusion recipients (550 257 women and 418 007 men; median age at first transfusion, 73.0 years [interquartile range, 59.8-82.4 years]) showed a U-shaped association between age of the blood donor and recipient mortality, with a nadir in recipients for the most common donor age group (40-49 years) and significant and increasing HRs among recipients of blood from donors of successively more extreme age groups (<20 years: HR, 1.12; 95% CI, 1.10-1.14; ≥70 years: HR, 1.25; 95% CI, 1.08-1.44). Higher mortality was also noted among recipients of blood from female donors (HR, 1.07; 95% CI, 1.07-1.07). Adjustments for number of transfusions with a linear term attenuated the associations, but the increased mortality for recipients of blood from young, old, and female donors was not eliminated. Closer examination of the association between number of transfusions and mortality revealed a nonlinear pattern. After adjustments to accommodate nonlinearity, donor age and sex were no longer associated with patient mortality.
Donor age and sex were not associated with patient survival and need not be considered in blood allocation. Any comparison between common and less common categories of transfusions will inevitably be confounded by the number of transfusions, which drives the probability of receiving the less common blood components. Previous positive findings regarding donor age and sex are most likely explained by residual confounding.
动物模型数据表明年轻供体的血液可能具有回春效果，之后至少有两项针对人类的观察性研究调查了供体年龄是否会影响患者的治疗结果。然而，结果相互矛盾。
研究供体年龄和性别与接受输血患者生存率之间的关联。
设计、地点和参与者：基于斯堪的纳维亚捐赠和输血数据库进行了一项回顾性队列研究，该数据库包含瑞典和丹麦的全国性数据，研究对象为2003年1月1日至2012年12月31日期间接受至少1次自体血或来自未知供体的红细胞输血的所有患者。对患者从首次输血开始进行随访，直至死亡、移民或随访结束。数据分析于2016年9月15日至11月15日进行。
不同年龄和性别的献血者的输血次数。在整个随访过程中，暴露因素被视为随时间变化的因素。
使用Cox比例风险回归估计的死亡风险比（HRs）和调整后的累积死亡率差异。
一项包括968264名输血接受者（550257名女性和418007名男性；首次输血时的中位年龄为73.0岁[四分位间距，59.8 - 82.4岁]）的粗分析结果显示，献血者年龄与接受者死亡率之间呈U形关联，最常见的供体年龄组（40 - 49岁）的接受者死亡率最低，而来自年龄组依次更为极端的献血者的血液接受者的HRs显著增加且呈上升趋势（<20岁：HR，1.12；95%置信区间，1.10 - 1.14；≥70岁：HR，1.25；95%置信区间，1.08 - 1.44）。接受女性献血者血液的接受者的死亡率也更高（HR，1.07；95%置信区间，1.07 - 1.07）。用线性项对输血次数进行调整后，这种关联有所减弱，但来自年轻、年老和女性献血者的血液接受者死亡率增加的情况并未消除。对输血次数与死亡率之间关联的进一步检查显示出非线性模式。在进行调整以适应非线性后，供体年龄和性别与患者死亡率不再相关。
供体年龄和性别与患者生存率无关，在血液分配中无需考虑。任何常见和不常见输血类别之间的比较不可避免地会受到输血次数的混淆，输血次数决定了接受不常见血液成分（的可能性）。先前关于供体年龄和性别的阳性发现很可能是由残余混杂因素导致的。
