输血相关循环超负荷的结局与危险因素：一项病例对照研究。

Outcomes and risk factors of transfusion-associated circulatory overload: a case control study.

作者信息

Daurat Aurélien, Grenie Jessie, Roger Claire, Daurat Gérald, Cuvillon Philippe, Muller Laurent, Lefrant Jean Yves

机构信息

Division Anesthésie Réanimation, Urgences Douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.

Délégation Qualité et Gestion des Risques, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.

出版信息

Transfusion. 2019 Jan;59(1):191-195. doi: 10.1111/trf.15040. Epub 2018 Nov 20.

DOI:10.1111/trf.15040

PMID:30456761

Abstract

BACKGROUND

Transfusion-associated circulatory overload (TACO) is a growing concern in clinical practice.

STUDY DESIGN AND METHODS

A case control study was performed at the Nîmes University Hospital, France. TACO cases occurring after RBC transfusion reported from January 1, 2014, to May 31, 2017, were included as cases. Four controls by case were randomly selected among the other RBC recipients on the same day.

RESULTS

During the study period, 60 TACO diagnoses were reported for 37,029 transfused RBCs to a total of 8787 patients; 240 controls were included. The average rate of TACO was one case every 616 RBCs transfused. One in 146 transfused patients experienced TACO. TACO was associated with a higher 28-day mortality (22% vs. 11%; p = 0.003), and a longer hospital stay compared with controls (23.5 ± 19.6 days vs. 15.9 ± 20.1 days; p < 0.001). Four risk factors were independently associated with TACO in multivariable analysis: chronic use of loop diuretics (odds ratio [OR], 6.5, 95% confidence interval [CI], 3.3-12.9), hemorrhagic shock (OR, 12; 95% CI, 2.9-50), body weight <46 kg (OR, 7.9; 95% CI, 2.3-26.8) and chronic hypertension (OR, 4.1; 95% CI, 2-8.5).

CONCLUSION

TACO was frequent and associated with poor outcome. Four independent risk factors were identified: hemorrhagic shock, low body weight, chronic use of diuretics, and chronic hypertension.

摘要

背景

输血相关循环超负荷（TACO）在临床实践中日益受到关注。

研究设计与方法

在法国尼姆大学医院进行了一项病例对照研究。纳入2014年1月1日至2017年5月31日期间报告的红细胞输血后发生的TACO病例作为病例组。在同一天的其他红细胞接受者中，按病例数随机选取4名对照。

结果

研究期间，在总共8787例接受红细胞输血的患者中，共报告了60例TACO诊断；纳入了240名对照。TACO的平均发生率为每输注616个红细胞出现1例病例。每146名输血患者中就有1人发生TACO。TACO与28天死亡率较高相关（22%对11%；p = 0.003），与对照组相比住院时间更长（23.5±19.6天对15.9±20.1天；p < 0.001）。多变量分析显示，有4个危险因素与TACO独立相关：长期使用袢利尿剂（比值比[OR]，6.5，95%置信区间[CI]，3.3 - 12.9）、失血性休克（OR，12；95% CI，2.9 - 50）、体重<46 kg（OR，7.9；95% CI，2.3 - 26.8）和慢性高血压（OR，4.1；95% CI，2 - 8.5）。