Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Peter Munk Cardiac Centre, University Health Network; Ted Rogers Centre for Heart Research; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Am Heart J. 2021 May;235:24-35. doi: 10.1016/j.ahj.2021.01.015. Epub 2021 Jan 23.
The benefit of red blood cell (RBC) transfusion in anemic critically-ill patients with cardiovascular disease is uncertain, as is the optimal threshold at which RBC transfusion should be considered. We sought to examine the association between RBC transfusion and mortality stratified by nadir Hgb level and admission diagnosis among cardiac intensive care unit (CICU) patients.
Retrospective single-center cohort of 11,754 CICU patients admitted between 2007 and 2018. The association between RBC transfusion and hospital mortality at each nadir Hgb (<8 g/dL, 8-9.9 g/dL, ≥10 g/dL) was assessed using multivariable logistic regression adjusted for the propensity to receive RBC transfusion.
The study population had a mean age of 68±15 years, including 38% females; 1,134 (11.4%) received RBC transfusion. Admission diagnoses included: acute coronary syndrome , 42%; heart failure, 50%; cardiac arrest , 12%; and cardiogenic shock , 12%. Patients who received RBC transfusion had higher crude hospital mortality (19% vs. 8%, P<.001). RBC transfusion was associated with lower adjusted hospital mortality in patients with nadir Hgb <8 g/dL after propensity adjustment, including subgroups with acute coronary syndrome, cardiac arrest, or cardiogenic shock (all P <.01). RBC transfusion was not associated with lower adjusted hospital mortality in any subgroup of patients with nadir Hgb ≥8 g/dL.
These observational data suggest the use of a Hgb threshold <8 g/dL for RBC transfusion in most CICU patients, although we could not exclude a potential benefit of RBC transfusion at a nadir Hgb of 8 to 9.9 g/dL; we did not observe any benefit from RBC transfusion at a nadir Hgb ≥10 g/dL.
对于患有心血管疾病的贫血危重症患者，红细胞（RBC）输血的益处尚不确定，何时应考虑输血的最佳阈值也不确定。我们试图研究心脏重症监护病房（CICU）患者根据最低血红蛋白（Hgb）水平和入院诊断分层的 RBC 输血与死亡率之间的关系。
这是一项回顾性的单中心队列研究，纳入了 2007 年至 2018 年期间入住 CICU 的 11754 例患者。使用多变量逻辑回归评估了每个最低 Hgb（<8 g/dL、8-9.9 g/dL、≥10 g/dL）水平时 RBC 输血与住院死亡率之间的关系，并根据接受 RBC 输血的倾向进行了调整。
研究人群的平均年龄为 68±15 岁，包括 38%的女性；1134 例（11.4%）接受了 RBC 输血。入院诊断包括：急性冠状动脉综合征占 42%；心力衰竭占 50%；心搏骤停占 12%；心源性休克占 12%。接受 RBC 输血的患者死亡率较高（19%比 8%，P<.001）。在进行倾向调整后，对于最低 Hgb<8 g/dL 的患者，RBC 输血与较低的调整后住院死亡率相关，包括急性冠状动脉综合征、心搏骤停或心源性休克的亚组（均 P<.01）。在最低 Hgb≥8 g/dL 的任何亚组患者中，RBC 输血与较低的调整后住院死亡率均无相关性。
这些观察性数据表明，对于大多数 CICU 患者，应将 Hgb 阈值<8 g/dL 用于 RBC 输血，尽管我们不能排除最低 Hgb 为 8 至 9.9 g/dL 时输血的潜在益处；我们没有观察到最低 Hgb≥10 g/dL 时输血有任何益处。
