Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Department of Medicine, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Intensive Care Med. 2022 Jan;37(1):100-106. doi: 10.1177/0885066620978770. Epub 2020 Dec 14.
Despite the importance of transfusion in treating sickle cell disease acute chest syndrome, the target hemoglobin and optimal modality for transfusion remain unknown.
To compare hospital length of stay (LOS) in intensive care unit (ICU) patients with acute chest syndrome transfused to hemoglobin ≥ 8 g/dL versus patients transfused to hemoglobin < 8 g/dL; and to compare hospital LOS in acute chest syndrome patients treated with and without exchange transfusion.
We performed a retrospective cohort study of all acute chest syndrome patients treated in the medical ICU at 2 tertiary care hospitals between January 2011 and August 2016 ( = 82). We compared median hospital LOS in patients transfused to hemoglobin ≥ 8 g/dL by the time of ICU transfer to the medical floor versus patients transfused to hemoglobin < 8 g/dL as well as patients who received exchange transfusion versus no exchange transfusion using Wilcoxon rank-sum tests. We modeled the association between hospital LOS and hemoglobin at ICU transfer to the medical floor using multivariable log-linear regression.
Median hospital LOS was about half as long for patients transfused to hemoglobin ≥ 8 g/dL versus hemoglobin < 8 g/dL (8.0 versus 16.5 days, = 0.008). There was no difference in LOS for patients treated with and without exchange transfusion. On average, a 1 g/dL increase in hemoglobin was associated with a 19.5% decrease (95% CI 10.8-28.2%) in LOS, controlling for possible confounding factors.
Transfusion to a hemoglobin target ≥ 8 g/dL is associated with decreased hospital LOS in patients with acute chest syndrome. There was no difference in LOS between patients who received exchange transfusion and those who did not.
尽管输血在治疗镰状细胞病急性胸痛综合征中至关重要，但目标血红蛋白和最佳输血方式仍不清楚。
比较血红蛋白≥8g/dL 与<8g/dL 的急性胸痛综合征患者 ICU 住院时间（LOS）；比较有无换血治疗的急性胸痛综合征患者 LOS。
我们对 2011 年 1 月至 2016 年 8 月在 2 家三级保健医院的内科 ICU 治疗的所有急性胸痛综合征患者进行了回顾性队列研究（n=82）。我们比较了 ICU 转至内科楼层时血红蛋白≥8g/dL 的患者与血红蛋白<8g/dL 的患者、接受换血治疗与未接受换血治疗的患者的中位 ICU 住院时间，采用 Wilcoxon 秩和检验。我们采用多变量对数线性回归模型来分析 ICU 转至内科楼层时血红蛋白与 LOS 之间的关系。
血红蛋白≥8g/dL 的患者 ICU 住院时间约为血红蛋白<8g/dL 的患者的一半（8.0 天 vs. 16.5 天，P=0.008）。接受换血治疗与未接受换血治疗的患者 LOS 无差异。血红蛋白平均每增加 1g/dL，LOS 降低 19.5%（95%CI 10.8-28.2%），控制了可能的混杂因素。
血红蛋白目标值≥8g/dL 的输血与急性胸痛综合征患者的住院时间缩短有关。接受换血治疗与未接受换血治疗的患者 LOS 无差异。
