创伤和产后出血患者输血的风险因素：CRASH-2 和 WOMAN 试验分析。
Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials.
机构信息
Department of Population Health, Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom.
Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria.
出版信息
PLoS One. 2020 Jun 3;15(6):e0233274. doi: 10.1371/journal.pone.0233274. eCollection 2020.
BACKGROUND
Hemorrhage is a leading cause of death after trauma and childbirth. In response to severe hemorrhage, bleeding patients often receive transfusions of red blood cells, plasma, platelets, or other blood components. We examined risk factors for transfusion in acute severe bleeding in two trials of over 20,000 patients to better understand factors associated with transfusion likelihood.
STUDY DESIGN AND METHODS
We conducted a cohort analysis of data from the CRASH-2 and WOMAN trials, two multinational trials that recruited patients with traumatic and postpartum hemorrhage, respectively. For each trial, we examined the effect of 10 factors on blood transfusion likelihood. Univariate and multivariate Poisson regressions were used to analyze the relationship between risk factors and blood transfusion.
RESULTS
Of the 20,207 traumatic hemorrhage patients, 10,232 (51%) received blood components. Of the 20,060 women with postpartum hemorrhage, 10,958 (55%) received blood components. For patients who suffered from traumatic hemorrhage, those greater than three hours from injury to hospitalization were more likely to be transfused (ARR 1.37; 95% CI, 1.20-1.56). Postpartum hemorrhage patients had an increased likelihood of transfusion if they gave birth outside the hospital (ARR 1.30; 95% CI 1.22-1.39), gave birth more than three hours before hospitalization (ARR 1.09; 95% CI 1.01-1.17), had a Caesarean section (ARR 1.16; 95% CI 1.08-1.25), and if they had any identifiable causes of hemorrhage other than uterine atony.
CONCLUSION
Several risk factors are associated with an increased likelihood of transfusion in traumatic and postpartum hemorrhage patients. Altering modifiable factors, by reducing time from injury or childbirth to hospitalization, for example, might be able to reduce transfusions and their complications.
TRIAL REGISTRATION
CRASH-2 is registered as ISRCTN86750102, ClinicalTrials.gov NCT00375258 and South African Clinical Trial Register DOH-27-0607-1919. WOMAN is registered as ISRCTN76912190, ClinicalTrials.gov NCT00872469, PACTR201007000192283, and EudraCT number 2008-008441-38.
背景
出血是创伤和分娩后死亡的主要原因。为了应对严重出血，出血患者经常接受红细胞、血浆、血小板或其他血液成分的输血。我们在两项超过 20000 名患者的试验中研究了急性严重出血患者的输血风险因素，以更好地了解与输血可能性相关的因素。
研究设计和方法
我们对 CRASH-2 和 WOMAN 试验的数据进行了队列分析，这两项多中心试验分别招募了创伤和产后出血的患者。对于每个试验，我们检查了 10 个因素对输血可能性的影响。使用单变量和多变量泊松回归分析了危险因素与输血之间的关系。
结果
在 20207 名创伤性出血患者中，有 10232 名（51%）接受了血液成分治疗。在 20060 名产后出血的女性中，有 10958 名（55%）接受了血液成分治疗。对于创伤性出血患者，如果从受伤到住院的时间超过 3 小时，更有可能接受输血（ARR 1.37；95%CI，1.20-1.56）。如果产后出血患者在医院外分娩（ARR 1.30；95%CI，1.22-1.39）、在住院前 3 小时以上分娩（ARR 1.09；95%CI，1.01-1.17）、进行剖宫产（ARR 1.16；95%CI，1.08-1.25）或有除子宫收缩乏力以外的任何可识别的出血原因，则输血的可能性增加。
结论
一些危险因素与创伤性和产后出血患者输血可能性增加有关。例如，通过减少从受伤或分娩到住院的时间等可改变的因素，可能能够减少输血及其并发症。
试验注册
CRASH-2 注册为 ISRCTN86750102、ClinicalTrials.gov NCT00375258 和南非临床试验登记处 DOH-27-0607-1919。WOMAN 注册为 ISRCTN76912190、ClinicalTrials.gov NCT00872469、PACTR201007000192283 和 EudraCT 编号 2008-008441-38。
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