老年血液与大量输血创伤患者的死亡率和不良事件增加相关：PROPPR 试验的二次分析。

Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial.

机构信息

School of Nursing, University of Alabama at Birmingham, Birmingham, AL.

Department of Pathology, University of Alabama at Birmingham, Birmingham, AL; Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL.

出版信息

Ann Emerg Med. 2019 Jun;73(6):650-661. doi: 10.1016/j.annemergmed.2018.09.033. Epub 2018 Nov 15.

DOI:10.1016/j.annemergmed.2018.09.033

PMID:30447946

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6517091/

Abstract

STUDY OBJECTIVE

The transfusion of older packed RBCs may be harmful in critically ill patients. We seek to determine the association between packed RBC age and mortality among trauma patients requiring massive packed RBC transfusion.

METHODS

We analyzed data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Subjects in the parent trial included critically injured adult patients admitted to 1 of 12 North American Level I trauma centers who received at least 1 unit of packed RBCs and were predicted to require massive blood transfusion. The primary exposure was volume of packed RBC units transfused during the first 24 hours of hospitalization, stratified by packed RBC age category: 0 to 7 days, 8 to 14 days, 15 to 21 days, and greater than or equal to 22 days. The primary outcome was 24-hour mortality. We evaluated the association between transfused volume of each packed RBC age category and 24-hour survival, using random-effects logistic regression, adjusting for total packed RBC volume, patient age, sex, race, mechanism of injury, Injury Severity Score, Revised Trauma Score, clinical site, and trial treatment group.

RESULTS

The 678 patients included in the analysis received a total of 8,830 packed RBC units. One hundred patients (14.8%) died within the first 24 hours. On multivariable analysis, the number of packed RBCs greater than or equal to 22 days old was independently associated with increased 24-hour mortality (adjusted odds ratio [OR] 1.05 per packed RBC unit; 95% confidence interval [CI] 1.01 to 1.08): OR 0.97 for 0 to 7 days old (95% CI 0.88 to 1.08), OR 1.04 for 8 to 14 days old (95% CI 0.99 to 1.09), and OR 1.02 for 15 to 21 days old (95% CI 0.98 to 1.06). Results of sensitivity analyses were similar only among patients who received greater than or equal to 10 packed RBC units.

CONCLUSION

Increasing quantities of older packed RBCs are associated with increased likelihood of 24-hour mortality in trauma patients receiving massive packed RBC transfusion (≥10 units), but not in those who receive fewer than 10 units.

摘要

研究目的

在危重症患者中，输注陈旧的浓缩红细胞可能有害。我们旨在确定创伤患者大量输注浓缩红细胞时，浓缩红细胞年龄与死亡率之间的关系。

方法

我们分析了 Pragmatic, Randomized Optimal Platelet and Plasma Ratios 试验的数据。该试验的入组对象为北美 12 家 1 级创伤中心收治的严重受伤的成年患者，这些患者至少输注了 1 单位浓缩红细胞，并预计需要大量输血。主要暴露因素是入院后 24 小时内输注的浓缩红细胞单位量，按浓缩红细胞年龄分组：0 至 7 天、8 至 14 天、15 至 21 天和大于等于 22 天。主要结局为 24 小时死亡率。我们使用随机效应逻辑回归评估了每个浓缩红细胞年龄组的输注量与 24 小时生存率之间的关系，调整了总浓缩红细胞量、患者年龄、性别、种族、损伤机制、损伤严重程度评分、修订创伤评分、临床地点和试验治疗组。

结果

分析共纳入 678 例患者，共输注了 8830 单位浓缩红细胞。100 例（14.8%）患者在 24 小时内死亡。多变量分析显示，输注大于等于 22 天的浓缩红细胞数量与 24 小时死亡率增加独立相关（校正后的每单位浓缩红细胞比值比 [OR] 1.05；95%置信区间 [CI] 1.01 至 1.08）：0 至 7 天的 OR 为 0.97（95% CI 0.88 至 1.08），8 至 14 天的 OR 为 1.04（95% CI 0.99 至 1.09），15 至 21 天的 OR 为 1.02（95% CI 0.98 至 1.06）。仅在输注大于等于 10 单位浓缩红细胞的患者中，敏感性分析结果相似。