围手术期输血与静脉血栓栓塞症
Perioperative Transfusions and Venous Thromboembolism.
机构信息
Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland.
Departments of Internal Medicine and Pediatrics, School of Medicine, Southern Illinois University and Mississippi Valley Regional Blood Center, Springfield, Illinois.
出版信息
Pediatrics. 2020 Apr;145(4). doi: 10.1542/peds.2019-2351. Epub 2020 Mar 20.
BACKGROUND AND OBJECTIVES
Annual incidence of venous thromboembolism (VTE) including postoperative VTE in hospitalized children is rising significantly. A growing body of evidence supports the role of red blood cells (RBCs) in pathologic thrombosis. In this study, we examined the association of perioperative RBC transfusion with postoperative VTE in pediatric patients.
METHODS
The pediatric databases of the American College of Surgeons' National Surgical Quality Improvement Project from 2012 to 2017 were used. Multivariable logistic regression was used to examine the association between perioperative RBC transfusion status and the development of new or progressive VTE within 30 days of surgery. The analyses were age stratified, as follows: neonates (≤28 days), infants (>28 days and <1 year), and children (≥1 year).
RESULTS
In this study, we included 20 492 neonates, 79 744 infants, and 382 862 children. Postoperative development of VTE was reported in 99 (0.48%) neonates, 147 (0.2%) infants, and 374 (0.1%) children. In all age groups, development of VTE was significantly more common among patients with a perioperative RBC transfusion than patients without a perioperative RBC transfusion (neonates: adjusted odds ratio [aOR] = 4.1, 95% confidence interval [CI] = 2.5-6.7; infants: aOR = 2.4, 95% CI = 1.7-3.6; children: aOR = 2.2, 95% CI = 1.7-2.9). Among children who received an intra- or postoperative transfusion, the weight-based volume of RBCs (mL/kg) transfused was associated with postoperative VTE in a dose-dependent manner: second tertile (odds ratio = 2.3, 95% CI = 1.3-4.1) and third tertile (odds ratio = 4.1, 95% CI = 2.3-7.4) versus first tertile.
CONCLUSIONS
Perioperative RBC transfusions are independently associated with development of new or progressive postoperative VTE in children, infants, and neonates. These findings need further validation in prospective studies and emphasize the need for evidence-based perioperative pediatric blood transfusion decisions.
背景与目的
包括术后静脉血栓栓塞症（VTE）在内的住院儿童静脉血栓栓塞症（VTE）的年发病率显著上升。越来越多的证据支持红细胞（RBC）在病理性血栓形成中的作用。在这项研究中，我们研究了围手术期 RBC 输血与儿科患者术后 VTE 的关系。
方法
使用美国外科医师学院国家手术质量改进计划的儿科数据库，时间范围为 2012 年至 2017 年。多变量逻辑回归用于检查围手术期 RBC 输血状态与术后 30 天内新发或进展性 VTE 发展之间的关系。分析按年龄分层，如下：新生儿（≤28 天）、婴儿（＞28 天和＜1 岁）和儿童（≥1 岁）。
结果
本研究共纳入 20492 例新生儿、79744 例婴儿和 382862 例儿童。报告术后 VTE 发展 99 例（0.48%）新生儿、147 例（0.2%）婴儿和 374 例（0.1%）儿童。在所有年龄组中，围手术期 RBC 输血的患者与未输血的患者相比，VTE 的发生率明显更高（新生儿：校正优势比[aOR] = 4.1，95%置信区间[CI] = 2.5-6.7；婴儿：aOR = 2.4，95% CI = 1.7-3.6；儿童：aOR = 2.2，95% CI = 1.7-2.9）。在接受术中或术后输血的儿童中，基于体重的 RBC 输注量（mL/kg）呈剂量依赖性与术后 VTE 相关：第二三分位数（比值比[OR] = 2.3，95%CI = 1.3-4.1）和第三三分位数（OR = 4.1，95%CI = 2.3-7.4）与第一三分位数相比。
结论
围手术期 RBC 输血与儿童、婴儿和新生儿新发或进展性术后 VTE 的发生独立相关。这些发现需要在前瞻性研究中进一步验证，并强调需要基于证据的围手术期儿科输血决策。
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