Moretti Katelyn, Marqués Catalina González, Garbern Stephanie, Mbanjumucyo Gabin, Uwamahoro Chantal, Beaudoin Francesca L, Amanullah Siraj, Gjelsvik Annie, Aluisio Adam R
Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA.
Brown University School of Public Health, Providence, USA.
Afr J Emerg Med. 2020 Jun;10(2):68-73. doi: 10.1016/j.afjem.2020.01.004. Epub 2020 Feb 6.
Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda.
This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013-16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL.
Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p = 0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51-3.21) as compared to those ≤5.0 mg/dL.
No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice.
来自高收入国家（HIC）的研究支持对内科患者采用限制性输血阈值。在低收入和中等收入国家（LMIC），贫血的病因和基线健康状况差异很大；最佳输血阈值尚不清楚。本研究评估了卢旺达基加利一家急诊中心（EC）患有内科疾病的患者中，不同血红蛋白水平下输注浓缩红细胞（PRBC）与死亡率之间的关联。
本回顾性队列研究使用了卢旺达基加利大学教学医院急诊中心就诊患者的随机样本。纳入年龄≥15岁、在2013 - 2016年期间因内科急症接受治疗且有急诊中心血红蛋白测量值的患者。使用逻辑回归评估急诊中心输注PRBC与患者死亡率之间的关系，并在血红蛋白水平为7mg/dL和5mg/dL时进行分层分析。
在抽取的3609例病例中，1116例符合纳入标准。中位年龄为42岁（四分位间距29, 60），女性占45.2%。12.1%的患者接受了输血。血液系统疾病（24.4%）和胃肠道疾病（20.7%）是接受输血患者的主要诊断。接受输血患者的比例死亡率较高，尽管无统计学意义（23.7%对17.0%，p = 0.06）。未发现PRBC输血导致总体死亡率调整后的比值有显著差异。在分层分析中，急诊中心血红蛋白>5.0mg/dL时接受输血的患者，与血红蛋白≤5.0mg/dL的患者相比，死亡几率是其2.21倍（95%置信区间1.51 - 3.21）。
在这个低收入和中等收入国家的环境中，未观察到急诊中心患者PRBC输血与死亡几率之间存在关联。初始血红蛋白>5mg/dL时接受PRBC输血的患者死亡率关联增加。结果表明，与高收入国家相比，PRBC输血的益处有限。应在低收入和中等收入国家开展进一步研究，评估内科疾病的紧急输血阈值，以指导实践。
