From the Division of Trauma, Emergency Surgery and Surgical Critical Care (C.J.N., M.E.H., J.P., J.F., A.E.M., N.S., D.R.K., P.J.F., G.C.V., H.M.A.K.), Massachusetts General Hospital, Boston, Massachusetts; Department of Trauma Surgery (C.J.N.), Leiden University Medical Center, Leiden, The Netherlands; Harvard Medical School (J.P., J.F., A.E.M., N.S., D.R.K., P.J.F., G.C.V., H.M.A.K.), Cambridge; and Center for Outcomes and Patient Safety in Surgery (COMPASS) (H.M.A.K.), Massachusetts General Hospital, Boston, Massachusetts.
J Trauma Acute Care Surg. 2020 Jul;89(1):51-57. doi: 10.1097/TA.0000000000002637.
The relationship between total transfusion volume and infection in the trauma patient remains unclear, especially at lower volumes of transfusion. We sought to quantify the cumulative, independent impact of transfusion within 24 hours of admission on the risk of infection in trauma patients.
Using the Trauma Quality Improvement Program 2013 to 2016 database, we included all patients who received blood transfusions in the first 4 hours. Patients who were transferred or had incomplete/wrongly coded information on transfusion volume were excluded. Patients were divided into 20 cohorts based on the total blood product volume transfused in the first 24 hours. A composite infection variable (INF) was created, including surgical site infection, ventilator-associated pneumonia, urinary tract infection, central line associated blood stream infection, and sepsis. Univariate and stepwise multivariable logistic regression analyses were performed to study the relationship between blood transfusion and INF, controlling for demographics (e.g., age, sex), comorbidities (e.g., cirrhosis, diabetes, steroid use), severity of injury (e.g., vital signs on arrival, mechanism, Injury Severity Score), and operative and angiographic interventions.
Of 1,002,595 patients, 37,568 were included. The mean age was 42 ± 18.6 years, 74.6% were males, 68% had blunt trauma, and median Injury Severity Score was 25 [17-34]. Adjusting for all available confounders, odds of INF increased incrementally from 1.00 (reference, 0-2 units) to 1.23 (95% confidence interval, 1.11-1.37) for 4 units transfused to 4.89 (95% confidence interval, 2.72-8.80) for 40 units transfused. Each additional unit increased the odds of INF by 7.6%.
Transfusion of the bleeding trauma patient was associated with a dose-dependent increased risk of infectious complications. Trauma surgeons and anesthesiologists should resuscitate the trauma patient until prompt hemorrhage control while avoiding overtransfusion.
Retrospective cohort study, Therapeutic IV.
创伤患者的总输血量与感染之间的关系尚不清楚，尤其是在输血量较低的情况下。我们旨在量化入院后 24 小时内输血的累积、独立影响，以确定其对创伤患者感染风险的影响。
利用创伤质量改进计划（Trauma Quality Improvement Program，TQIP）2013 年至 2016 年的数据库，纳入所有在前 4 小时内接受输血的患者。排除了转院或输血量信息不完整/错误的患者。根据前 24 小时内输注的全血制品总量，将患者分为 20 个队列。创建一个复合感染变量（INF），包括手术部位感染、呼吸机相关性肺炎、尿路感染、中心静脉相关血流感染和败血症。采用单变量和逐步多变量逻辑回归分析，研究输血与 INF 之间的关系，并控制了人口统计学因素（如年龄、性别）、合并症（如肝硬化、糖尿病、激素使用）、损伤严重程度（如到达时的生命体征、机制、损伤严重程度评分）以及手术和血管造影干预措施。
在 1002595 例患者中，纳入了 37568 例。患者平均年龄为 42 ± 18.6 岁，74.6%为男性，68%为钝器伤，损伤严重程度评分为中位数 25 [17-34]。调整所有可用的混杂因素后，与输注 0-2 单位相比，输注 4 单位的感染几率从 1.00（参考值）增加至 1.23（95%置信区间，1.11-1.37），输注 40 单位的感染几率从 1.00 增加至 4.89（95%置信区间，2.72-8.80）。每增加一个单位，感染的几率就会增加 7.6%。
输注出血性创伤患者的血液与感染并发症的风险呈剂量依赖性增加有关。创伤外科医生和麻醉师应在迅速控制出血的同时复苏创伤患者，避免过度输血。
回顾性队列研究，治疗性 IV 级。
