Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Haematology, Monash Health, Melbourne, Australia.
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care Medicine, Western Health, Melbourne, Australia.
Transfus Med Rev. 2018 Apr;32(2):77-88. doi: 10.1016/j.tmrv.2018.02.002. Epub 2018 Feb 17.
Longer storage duration of red blood cell (RBC) units prior to transfusion has been associated with worse outcomes in observational studies. We performed a systematic review, including recently published randomized trials, to determine if storage age of RBCs is associated with mortality, morbidity or adverse events in patients. Searches were performed up to 21 July 2017 in Medline (OvidSP), 20 July in EMBASE (OvidSP) and June 2017 in Cochrane Library. Eligible studies were randomized controlled trials comparing transfusion of fresher or freshest available with older or standard issue RBCs. Human volunteer and autologous RBC transfusion studies were excluded. Data were extracted from published reports independently by 2 authors and strength of evidence assessed according to GRADE criteria. The primary outcome was latest-reported mortality. Sixteen trials randomizing 31,359 patients were identified. Transfusion with fresher compared with older RBC was not associated with risk of death (relative risk [RR] 1.04, 95% CI 0.98-1.09; P=.20, I=0%, high quality evidence), but was associated with higher risk of transfusion reactions (RR 1.35, 95% CI 1.04-1.76; P=.02; I=0%; high quality evidence) and infection (RR 1.08, 95% CI 1.00-1.17; P=.05; I=0%, moderate evidence). Trial sequential analysis showed required information size has now been reached to exclude a 10% relative risk increase or decrease in mortality. Transfusion of fresher RBCs is not associated with decreased risk of death but is associated with higher rates of transfusion reactions and possibly infection. The current evidence does not support a change from current usual transfusion practice.
在输血前将红细胞（RBC）单位的储存时间延长与观察性研究中的不良结果相关。我们进行了一项系统评价，包括最近发表的随机试验，以确定 RBC 的储存年龄是否与患者的死亡率、发病率或不良事件相关。截至 2017 年 7 月 21 日在 Medline（OvidSP）、7 月 20 日在 EMBASE（OvidSP）和 2017 年 6 月在 Cochrane Library 进行了检索。合格的研究是比较输注较新鲜或最新的可用红细胞与较陈旧或标准供应红细胞的随机对照试验。排除了人类志愿者和自体 RBC 输血研究。数据由 2 位作者独立从已发表的报告中提取，根据 GRADE 标准评估证据强度。主要结局是最新报告的死亡率。确定了 16 项随机分配 31359 名患者的试验。与输注较陈旧的 RBC 相比，输注较新鲜的 RBC 与死亡风险无关（相对风险 [RR] 1.04，95%置信区间 [CI] 0.98-1.09；P=.20，I=0%，高质量证据），但与输血反应（RR 1.35，95%CI 1.04-1.76；P=.02；I=0%；高质量证据）和感染（RR 1.08，95%CI 1.00-1.17；P=.05；I=0%，中等质量证据）的风险增加相关。试验序贯分析表明，现在已经达到排除死亡率相对风险增加或降低 10%所需的信息量。输注较新鲜的 RBC 与死亡风险降低无关，但与输血反应发生率增加和可能的感染相关。目前的证据不支持改变当前的常规输血实践。
