Yu Alison J, Inaba Kenji, Biswas Subarna, de Leon Luis Alejandro, Wong Monica, Benjamin Elizabeth, Lam Lydia, Demetriades Demetrios
Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Am Surg. 2018 Oct 1;84(10):1617-1621.
The objective of this study was to determine the survival outcome associated with large-volume blood transfusion after trauma. This was a retrospective study at a Level I trauma center from January 2000 to December 2014 that included trauma patients who received ≥25 units packed red blood cell (pRBC) within the first 24 hours of hospital admission. Univariate and multivariable logistic regressions identified risk factors for mortality. Receiver operating characteristic curve analysis evaluated the ability of pRBC volume to predict mortality. Among 74,065 adults (≥18 years old), 178 patients (0.24%) received ≥25 units of pRBC in the first 24 hours, of which 142 (79.8%) received 25 to 49 units, 28 (15.7%) received 50 to 74 units, and 8 (4.5%) received ≥75 units. Overall, 92.2 per cent were male, mean age 33.9 (±14.0), mean Injury Severity Score 28.9 (±14.3), and median Glasgow Coma Scale score 12 (3-15). The overall mortality was 65.2 per cent and 64.1 per cent for those receiving 25 to 49 units, 64.3 per cent for 50 to 74 units, and 87.5 per cent for ≥75 units. In univariate analysis, female gender was associated with lower mortality [odds ratio (OR) 0.24, = 0.025]. Decreasing Glasgow Coma Scale (OR 0.82, < 0.001), increasing Injury Severity Score (OR 1.07, < 0.001), and thoracotomy (OR 3.91, < 0.001) were associated with higher mortality. There was no transfusion cutoff that was significantly associated with higher mortality.
本研究的目的是确定创伤后大量输血相关的生存结局。这是一项在一级创伤中心开展的回顾性研究，时间跨度为2000年1月至2014年12月，纳入了在入院后24小时内接受≥25单位浓缩红细胞（pRBC）的创伤患者。单因素和多因素逻辑回归分析确定了死亡的危险因素。受试者工作特征曲线分析评估了pRBC量预测死亡的能力。在74065名成年人（≥18岁）中，178名患者（0.24%）在最初24小时内接受了≥25单位的pRBC，其中142名（79.8%）接受了25至49单位，28名（15.7%）接受了50至74单位，8名（4.5%）接受了≥75单位。总体而言，92.2%为男性，平均年龄33.9（±14.0），平均损伤严重度评分28.9（±14.3），格拉斯哥昏迷量表评分中位数为12（3 - 15）。接受25至49单位的患者总体死亡率为65.2%，接受50至74单位的为64.1%，接受≥75单位的为87.5%。在单因素分析中，女性性别与较低死亡率相关[比值比（OR）0.24， = 0.025]。格拉斯哥昏迷量表评分降低（OR 0.82， < 0.001）、损伤严重度评分增加（OR 1.07， < 0.001）和开胸手术（OR 3.91， < 0.001）与较高死亡率相关。没有输血阈值与较高死亡率显著相关。
