CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Quebec City, QC, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Can J Anaesth. 2019 Jun;66(6):696-705. doi: 10.1007/s12630-019-01326-7. Epub 2019 Feb 26.
Anemia is common in critically ill patients with traumatic brain injury, and often requires red blood cell transfusion. Studies suggest that prolonged storage causes lesions of the red blood cells, including a decreased ability to carry oxygen. Considering the susceptibility of the brain to hypoxemia, victims of traumatic brain injury may thus be more vulnerable to exposure to older red blood cells.
Our study aimed to ascertain whether the administration of fresh red blood cells (seven days or less) results in a better neurologic outcome compared with standard red blood cells in critically ill patients with traumatic brain injury requiring transfusion. The Age of Blood Evaluation in traumatic brain injury (ABLE-tbi) study was a nested study within the ABLE study (ISRCTN44878718). Our primary outcome was the extended Glasgow Outcome Scale (GOSe) at six months.
In the ABLE study, 217 subjects suffered a traumatic brain injury: 110 in the fresh group, and 107 in the standard group. In the fresh group, 68 (73.1%) of the patients had an unfavourable neurologic outcome (GOSe ≤ 4) compared with 60 (64.5%) in the standard group (P = 0.21). Using a sliding dichotomy approach, we observed no overall effect of fresh red blood cells on neurologic outcome (odds ratio [OR], 1.34; 95% confidence interval [CI], 0.72 to 2.50; P = 0.35) but observed differences across prognostic bands with a decreased odds of unfavourable outcome in patients with the best prognosis at baseline (OR, 0.33; 95% CI, 0.11 to 0.96; P = 0.04) but an increased odds in those with intermediate and worst baseline prognosis (OR, 5.88; 95% CI,1.66 to 20.81; P = 0.006; and OR, 1.67; 95% CI, 0.53 to 5.30; P = 0.38, respectively).
Overall, transfusion of fresh red blood cells was not associated with a better neurologic outcome at six months in critically ill patients with traumatic brain injury. Nevertheless, we cannot exclude a differential effect according to the patient baseline prognosis.
ABLE study (ISRCTN44878718); registered 22 August, 2008.
创伤性脑损伤的危重症患者常发生贫血，通常需要输血。研究表明，红细胞的储存时间过长会导致红细胞损伤，包括携氧能力下降。考虑到大脑对低氧血症的敏感性，创伤性脑损伤的受害者可能更容易受到较老的红细胞的影响。
我们的研究旨在确定在需要输血的创伤性脑损伤危重症患者中，输注新鲜红细胞（7 天或更短）是否比输注标准红细胞的神经功能结局更好。Age of Blood Evaluation in traumatic brain injury (ABLE-tbi) 研究是 ABLE 研究中的一个嵌套研究（ISRCTN44878718）。我们的主要结局是 6 个月时扩展的格拉斯哥结局量表（GOSe）。
在 ABLE 研究中，217 名患者发生创伤性脑损伤：新鲜组 110 例，标准组 107 例。在新鲜组中，68 例（73.1%）患者的神经功能结局不良（GOSe≤4），而标准组中 60 例（64.5%）（P=0.21）。使用滑动二分法，我们没有观察到新鲜红细胞对神经功能结局的总体影响（比值比[OR]，1.34；95%置信区间[CI]，0.72 至 2.50；P=0.35），但在不同预后组之间存在差异，在基线预后最佳的患者中，不良结局的可能性降低（OR，0.33；95%CI，0.11 至 0.96；P=0.04），而在基线预后中等和最差的患者中，不良结局的可能性增加（OR，5.88；95%CI，1.66 至 20.81；P=0.006；OR，1.67；95%CI，0.53 至 5.30；P=0.38）。
总体而言，在创伤性脑损伤的危重症患者中，输注新鲜红细胞与 6 个月时的神经功能结局无相关性。然而，我们不能排除根据患者基线预后的差异效应。
ABLE 研究（ISRCTN44878718）；2008 年 8 月 22 日注册。
