Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH.
Pediatr Crit Care Med. 2020 Aug;21(8):e475-e484. doi: 10.1097/PCC.0000000000002338.
To test the hypothesis that early RBC transfusion is associated with duration of organ dysfunction in critically ill septic children.
Secondary analysis of a single-center prospective observational study. Multivariable negative binomial regression was used to determine relationships between RBC transfusion within 48 hours of sepsis onset and number of days in 14 with organ dysfunction, or with multiple organ dysfunction syndrome.
A PICU at a quaternary care children's hospital.
Children less than 18 years old with severe sepsis/septic shock by consensus criteria were included. Patients with RBC transfusion prior to sepsis onset and those on extracorporeal membrane oxygenation support within 48 hours of sepsis onset were excluded.
None.
Ninety-four patients were included. Median age was 6 years (0-13 yr); 61% were male. Seventy-eight percentage had septic shock, and 41 (44%) were transfused RBC within 48 hours of sepsis onset (early RBC transfusion). On multivariable analyses, early RBC transfusion was independently associated with 44% greater organ dysfunction days (adjusted relative risk, 1.44 [1.04-2.]; p = 0.03), although risk differed by severity of illness (interaction p = 0.004) and by shock severity (interaction p = 0.04 for Vasoactive Inotrope Score and 0.03 for shock index). Relative risks for multiple organ dysfunction syndrome days varied by shock severity (interaction p = 0.008 for Vasoactive Inotrope Score and 0.01 for shock index). Risks associated with early RBC transfusion were highest for the children with the lowest shock severities.
In agreement with previous studies, early RBC transfusion was independently associated with longer duration of organ dysfunction. Ours is among the first studies to document different transfusion-associated risks based on clinically available measures of shock severity, demonstrating greater transfusion-associated risks in children with less severe shock. Larger multicenter studies to verify these interaction effects are essential to plan much-needed RBC transfusion trials for critically ill septic children.
验证假说，即早期红细胞输注与危重症脓毒症儿童器官功能障碍持续时间有关。
单中心前瞻性观察研究的二次分析。多变量负二项回归用于确定脓毒症发病后 48 小时内红细胞输注与 14 天内器官功能障碍或多器官功能障碍综合征天数之间的关系。
一家四级儿童医院的 PICU。
符合共识标准的严重脓毒症/脓毒性休克的年龄小于 18 岁的儿童。排除脓毒症发病前接受红细胞输注和脓毒症发病后 48 小时内接受体外膜氧合支持的患者。
无。
共纳入 94 例患者。中位年龄为 6 岁（0-13 岁）；61%为男性。78%患有脓毒性休克，41 例（44%）在脓毒症发病后 48 小时内接受红细胞输注（早期红细胞输注）。多变量分析显示，早期红细胞输注与器官功能障碍天数增加 44%独立相关（校正后的相对风险，1.44 [1.04-2.]；p = 0.03），尽管风险因疾病严重程度而异（交互作用 p = 0.004）和休克严重程度而异（血管活性药物评分的交互作用 p = 0.04，休克指数的交互作用 p = 0.03）。多器官功能障碍综合征天数的相对风险因休克严重程度而异（血管活性药物评分的交互作用 p = 0.008，休克指数的交互作用 p = 0.01）。与早期红细胞输注相关的风险在休克严重程度最低的儿童中最高。
与先前的研究一致，早期红细胞输注与器官功能障碍持续时间延长独立相关。我们的研究是首批记录基于临床可用休克严重程度测量的不同输血相关风险的研究之一，证明在休克程度较轻的儿童中，输血相关风险更高。进行更大规模的多中心研究以验证这些相互作用效应对于计划急需的危重症脓毒症儿童的红细胞输注试验至关重要。
