Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia.
Respirology. 2018 Oct;23(10):935-941. doi: 10.1111/resp.13314. Epub 2018 Apr 24.
Blood transfusion has been associated with adverse outcomes in certain conditions. This study investigates the prevalence and outcomes of red blood cell (RBC) transfusion in patients with acute pulmonary embolism (PE).
Retrospective study of consecutive patients from 2000 to 2012 admitted to a tertiary hospital with a primary diagnosis of acute PE. Transfusion status during the hospital admission was ascertained. Mortality was tracked from a state-wide death database and analysed using multivariable modelling.
A total of 73 patients (5% of all patients admitted with PE) received RBC transfusion during their admission. These patients were significantly older, had more co-morbidities, worse haemodynamics, higher simplified pulmonary embolism severity index scores, and lower plasma sodium and haemoglobin (Hb) levels at admission. Unadjusted mortality for the transfused group was significantly higher at 30-day (19% vs 4%, P < 0.001) and 6-month (40% vs 10%, P < 0.001) follow-up. Multivariable modelling showed RBC transfusion to be a significant independent predictor of mortality at 30-day (odds ratio 3.06, 95% CI: 1.17-8.01, P = 0.02) and 6-month (hazard ratio (HR) 1.97, 95% CI: 1.12-3.46, P = 0.02). Sensitivity analysis confirmed that transfused patients had higher mortality than non-transfused patients in the subgroup of patients with Hb <100 g/L.
RBC transfusion in patients hospitalized with acute PE is rare and appears to be associated with increased risk of short- and long-term mortality, independent of Hb level on admission. This finding underscores the need for future randomized controlled studies on the impact of RBC transfusion in the management of patients admitted with acute PE. [Correction added on 4 May 2018, after first online publication: the word 'serum' was changed to 'plasma' throughout the article where appropriate.].
在某些情况下，输血与不良结局相关。本研究旨在调查急性肺栓塞（PE）患者中红细胞（RBC）输血的流行情况及其结局。
回顾性分析 2000 年至 2012 年期间在一家三级医院因急性 PE 住院的连续患者。确定住院期间的输血情况。从全州死亡数据库中追踪死亡率，并使用多变量模型进行分析。
共有 73 例（所有住院治疗 PE 患者的 5%）患者在住院期间接受了 RBC 输血。这些患者年龄较大，合并症较多，血流动力学更差，简化的肺栓塞严重程度指数评分更高，入院时血浆钠和血红蛋白（Hb）水平更低。未校正的输血组 30 天（19%比 4%，P < 0.001）和 6 个月（40%比 10%，P < 0.001）随访时死亡率显著更高。多变量模型显示 RBC 输血是 30 天（优势比 3.06，95%置信区间：1.17-8.01，P = 0.02）和 6 个月（风险比（HR）1.97，95%置信区间：1.12-3.46，P = 0.02）死亡的独立显著预测因素。敏感性分析证实，在 Hb <100 g/L 的患者亚组中，输血患者的死亡率高于未输血患者。
在因急性 PE 住院的患者中，RBC 输血很少见，且似乎与短期和长期死亡率增加相关，与入院时的 Hb 水平无关。这一发现强调了未来需要进行关于 RBC 输血对急性 PE 患者管理影响的随机对照研究。[2018 年 5 月 4 日在线发表后更正：文章中适当的地方将“血清”改为“血浆”。]
