Department of Medicine, Ottawa General Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Department of Medicine and Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
Transfusion. 2020 Sep;60(9):1929-1939. doi: 10.1111/trf.15933. Epub 2020 Aug 28.
An increased risk of complications, including death, has been associated with stored red blood cell (RBC) units in observational studies but not in randomized trials. We aimed to evaluate for volume-dependent effects attributable to length of RBC storage in a secondary analysis of the Age of Blood Evaluation (ABLE) trial.
In the 2510 critically ill adults from the ABLE trial randomized to receive RBC units stored not more than 7 days or the oldest compatible RBC units, we estimated the hazard ratio (HR) for death by intensive care unit (ICU) and hospital discharge and by days 28, 90, and 180, within subgroups defined by the number of RBC units received. Extended Cox proportional hazards regression was used to model the HR.
A volume-dependent effect of storage age on survival was present for death by 90 and 180 days, but not earlier endpoints. The HR for death by 90 days was 0.55 (95% confidence interval [CI], 0.11-0.98, fresh vs standard) after transfusion of 6 RBC units but 1.45 (95% CI, 1.06-1.98) after transfusion of 1 RBC unit.
In this exploratory analysis, volume-dependent effects related to RBC storage were documented in the ABLE trial. The harms associated with small volumes of fresh RBC units and large volumes of older RBC units should be further explored.
观察性研究表明，储存的红细胞（RBC）单位与并发症风险增加有关，包括死亡，但随机试验并未发现这种关联。我们旨在 ABLE 试验的二次分析中评估与 RBC 储存时间相关的与体积有关的影响。
在 ABLE 试验中，2510 名危重症成年人被随机分配接受储存不超过 7 天的 RBC 单位或最陈旧的相容 RBC 单位。我们根据接受的 RBC 单位数量，估计了 ICU 和医院出院时以及第 28、90 和 180 天时死亡的风险比（HR）。使用扩展 Cox 比例风险回归来模拟 HR。
储存年龄对生存的影响与 90 天和 180 天的死亡有关，但与更早的终点无关。输注 6 单位 RBC 后，90 天死亡的 HR 为 0.55（95%置信区间 [CI]，0.11-0.98，新鲜 vs 标准），但输注 1 单位 RBC 后为 1.45（95% CI，1.06-1.98）。
在这项探索性分析中，在 ABLE 试验中记录了与 RBC 储存相关的与体积有关的影响。应进一步探讨与小体积新鲜 RBC 单位和大体积陈旧 RBC 单位相关的危害。
