红细胞输注年龄与危重症成年患者结局的关系。
Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults.
机构信息
From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.).
出版信息
N Engl J Med. 2017 Nov 9;377(19):1858-1867. doi: 10.1056/NEJMoa1707572. Epub 2017 Sep 27.
BACKGROUND
It is uncertain whether the duration of red-cell storage affects mortality after transfusion among critically ill adults.
METHODS
In an international, multicenter, randomized, double-blind trial, we assigned critically ill adults to receive either the freshest available, compatible, allogeneic red cells (short-term storage group) or standard-issue (oldest available), compatible, allogeneic red cells (long-term storage group). The primary outcome was 90-day mortality.
RESULTS
From November 2012 through December 2016, at 59 centers in five countries, 4994 patients underwent randomization and 4919 (98.5%) were included in the primary analysis. Among the 2457 patients in the short-term storage group, the mean storage duration was 11.8 days. Among the 2462 patients in the long-term storage group, the mean storage duration was 22.4 days. At 90 days, there were 610 deaths (24.8%) in the short-term storage group and 594 (24.1%) in the long-term storage group (absolute risk difference, 0.7 percentage points; 95% confidence interval [CI], -1.7 to 3.1; P=0.57). At 180 days, the absolute risk difference was 0.4 percentage points (95% CI, -2.1 to 3.0; P=0.75). Most of the prespecified secondary measures showed no significant between-group differences in outcome.
CONCLUSIONS
The age of transfused red cells did not affect 90-day mortality among critically ill adults. (Funded by the Australian National Health and Medical Research Council and others; TRANSFUSE Australian and New Zealand Clinical Trials Registry number, ACTRN12612000453886 ; ClinicalTrials.gov number, NCT01638416 .).
背景
异体输用的红细胞储存时间是否会影响危重症成年患者的输血后死亡率尚不确定。
方法
在一项国际性、多中心、随机、双盲试验中，我们将危重症成年患者分配至输注最新获得的、相容的异体红细胞（短期储存组）或标准库存（最早获得的、相容的异体红细胞）（长期储存组）。主要结局为 90 天死亡率。
结果
2012 年 11 月至 2016 年 12 月，在 5 个国家的 59 个中心，共有 4994 例患者接受了随机分组，其中 4919 例（98.5%）纳入主要分析。在短期储存组的 2457 例患者中，平均储存时间为 11.8 天。在长期储存组的 2462 例患者中，平均储存时间为 22.4 天。90 天时，短期储存组有 610 例死亡（24.8%），长期储存组有 594 例（24.1%）（绝对风险差异，0.7 个百分点；95%置信区间[CI]，-1.7 至 3.1；P=0.57）。180 天时，绝对风险差异为 0.4 个百分点（95%CI，-2.1 至 3.0；P=0.75）。大多数预先指定的次要措施显示两组间结局无显著差异。
结论
输注的红细胞年龄不影响危重症成年患者的 90 天死亡率。（由澳大利亚国家卫生和医学研究理事会等资助；TRANSFUSE 澳大利亚和新西兰临床试验注册编号：ACTRN12612000453886；ClinicalTrials.gov 编号：NCT01638416。）
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