Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark.
Acta Anaesthesiol Scand. 2020 May;64(5):641-647. doi: 10.1111/aas.13538. Epub 2020 Jan 12.
Use of a lower haemoglobin (Hb) threshold to guide red blood cell (RBC) transfusion is now generally recommended in critically ill patients, but uncertainty remains regarding the optimal Hb threshold for RBC transfusion in patients of different ages.
We conducted a post-hoc analysis of 998 patients with septic shock and anaemia randomised to RBC transfusion at a Hb threshold of 7 g/dl [4.3 mmol/l] vs 9 g/dl [5.6 mmol/l] in the Transfusion Requirements in Septic Shock (TRISS) trial. We assessed if there were heterogeneous effects between the allocated Hb threshold and patient age categorised and on the continuous scale. The primary outcome was 1-year mortality; the secondary outcome was 90-day mortality. Both outcomes were analysed using logistic regression models and in sensitivity analyses with additional adjusting for site of enrolment, presence of haematological malignancy and the Sequential Organ Failure Assessment (SOFA) score. The secondary analyses were Kaplan-Meier curves with corresponding log-rank tests.
We found no heterogeneity between patient age and the allocated Hb thresholds for RBC transfusion for 1-year mortality or 90-day mortality in the primary analyses. The sensitivity analyses suggested heterogeneity between age groups regarding 90-day mortality, however, this was not consistent for 1-year mortality or when assessing age on the continuous scale.
In this post-hoc study of ICU patients with septic shock, we found no reliable heterogeneous effects of transfusion at a Hb threshold of 7 vs 9 g/dl according to patient age on mortality. However, due to low power, this study should only be considered as hypothesis generating.
目前普遍建议在危重症患者中使用较低的血红蛋白（Hb）阈值来指导红细胞（RBC）输血，但对于不同年龄患者的 RBC 输血最佳 Hb 阈值仍存在不确定性。
我们对接受 RBC 输血的 998 例败血症性休克和贫血患者进行了事后分析，这些患者在 TRISS 试验中被随机分配至 Hb 阈值为 7 g/dl [4.3 mmol/l]与 9 g/dl [5.6 mmol/l]。我们评估了分配的 Hb 阈值与患者年龄分类之间以及连续尺度上是否存在异质性效应。主要结局为 1 年死亡率；次要结局为 90 天死亡率。使用逻辑回归模型和敏感性分析对这两个结局进行分析，后者还额外调整了入组地点、血液恶性肿瘤的存在和序贯器官衰竭评估（SOFA）评分。次要分析为 Kaplan-Meier 曲线和相应的对数秩检验。
我们在主要分析中未发现患者年龄与 RBC 输血分配的 Hb 阈值之间存在 1 年死亡率或 90 天死亡率的异质性。敏感性分析提示年龄组之间在 90 天死亡率方面存在异质性，但这在 1 年死亡率或评估连续尺度上的年龄时并不一致。
在这项 ICU 败血症性休克患者的事后研究中，我们未发现根据死亡率输血在 Hb 阈值为 7 与 9 g/dl 之间存在与患者年龄相关的可靠异质性效应。然而，由于效力较低，本研究仅应视为假设产生。
