Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Mississippi Valley Regional Blood Center, and Simmons Cancer Institute at SIU SOM, Springfield, Illinois, USA.
Transfusion. 2020 Aug;60(8):1700-1712. doi: 10.1111/trf.15855. Epub 2020 Jun 26.
Factors associated with red blood cell (RBC), plasma, and platelet transfusions in hospitalized neonates and children across the United States have not been well characterized.
Data from the Kids' Inpatient Database (KID) 2016 were analyzed. KID is a random sample of 10% of all uncomplicated in-hospital births and 80% of remaining pediatric discharges from approximately 4200 US hospitals. Sampling weights were applied to generate nationally representative estimates. Primary outcome was one or more RBC transfusion procedures; plasma and platelet transfusions were assessed as secondary outcomes. Analysis was stratified by age: neonates (NEO; ≤28 d), and nonneonates (PED; >28 d and <18 y). Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs).
Among 5,604,984 total hospitalizations, overall prevalence of transfusions was 1.07% (95% CI, 0.94%-1.22%) for RBCs, 0.17% (95% CIs, 0.15%-0.21%) for plasma and 0.35% (95% CI, 0.30%-0.40%) for platelet transfusions. RBC transfusions occurred among 0.43% NEO admissions and 2.63% PED admissions. For NEO admissions, RBC transfusion was positively associated with nonwhite race, longer length of hospitalization, highest risk of mortality (aOR, 86.58; 95% CI, 64.77-115.73) and urban teaching hospital location. In addition to the above factors, among PED admissions, RBC transfusion was positively associated with older age, female sex (aOR, 1.10; 95% CI, 1.07-1.13), and elective admission status (aOR, 1.62; 95% CI, 1.46-1.80). Factors associated with plasma and platelet transfusions were largely similar to those associated with RBC transfusion, except older age groups had lower odds of plasma transfusion among PED admissions.
While there is substantial variability in the proportion of neonates and nonneonatal children transfused nationally, there are several similar, yet unique, nonlaboratory predictors of transfusion identified in these age groups.
在美国，住院新生儿和儿童的红细胞（RBC）、血浆和血小板输注相关因素尚未得到充分描述。
对 2016 年儿童住院数据库（KID）的数据进行了分析。KID 是全美约 4200 家医院无并发症住院分娩的 10%和其余儿科出院人数的 80%的随机样本。采用抽样权重生成全国代表性估计值。主要结局为一次或多次 RBC 输注；将血浆和血小板输注评估为次要结局。按年龄分层分析：新生儿（NEO；≤28 天）和非新生儿（PED；>28 天且<18 岁）。采用多变量逻辑回归估计调整后的优势比（aOR）和 95%置信区间（95%CI）。
在 5604984 例总住院人数中，RBC、血浆和血小板输注的总输注率分别为 0.94%-1.22%、0.15%-0.21%和 0.30%-0.40%。NEO 入院患者中 0.43%接受 RBC 输注，PED 入院患者中 2.63%接受 RBC 输注。对于 NEO 入院患者，RBC 输注与非白人种族、住院时间延长、最高死亡率风险（aOR，86.58；95%CI，64.77-115.73）和城市教学医院位置呈正相关。除上述因素外，对于 PED 入院患者，RBC 输注与年龄较大、女性（aOR，1.10；95%CI，1.07-1.13）和择期入院状态（aOR，1.62；95%CI，1.46-1.80）呈正相关。与 RBC 输注相关的血浆和血小板输注的因素在很大程度上相似，但在 PED 入院患者中，年龄较大的人群接受血浆输注的可能性较低。
尽管全国新生儿和非新生儿接受输血的比例存在很大差异，但在这些年龄组中，有几个相似但又独特的非实验室输血预测因素。
