Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris AP-HP.Centre, Paris, France.
Université de Paris, Paris, France.
Crit Care Med. 2021 Jun 1;49(6):912-922. doi: 10.1097/CCM.0000000000004887.
Transfusions of blood products are common in critically ill patients and have a potential for immunomodulation. The aim of this study is to address the impact of transfusion of blood products on the susceptibility to ICU-acquired infections in the high-risk patients with septic shock.
A single-center retrospective study over a 10-year period (2008-2017).
A medical ICU of a tertiary-care center.
All consecutive patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients who were discharged or died within the first 48 hours were excluded.
RBC, platelet, and fresh frozen plasma transfusions collected up to 24 hours prior to the onset of ICU-acquired infection.
During the study period, 1,152 patients were admitted for septic shock, with 893 patients remaining alive in the ICU after 48 hours of management. A first episode of ICU-acquired infection occurred in 28.3% of the 48-hour survivors, with a predominance of pulmonary infections (57%). Patients with ICU-acquired infections were more likely to have received RBC, platelet, and fresh frozen plasma transfusions. In a multivariate Cox cause-specific analysis, transfusions of platelets (cause-specific hazard ratio = 1.55 [1.09-2.20]; p = 0.01) and fresh frozen plasma (cause-specific hazard ratio = 1.38 [0.98-1.92]; p = 0.05) were independently associated with the further occurrence of ICU-acquired infections.
Transfusions of platelets and fresh frozen plasma account for risk factors of ICU-acquired infections in patients recovering from septic shock. The occurrence of ICU-acquired infections should be considered as a relevant endpoint in future studies addressing the indications of transfusions in critically ill patients.
在危重病患者中，血液制品的输注很常见，并且具有潜在的免疫调节作用。本研究旨在探讨输血对脓毒性休克高危患者发生 ICU 获得性感染的易感性的影响。
一项回顾性单中心研究，时间跨度为 10 年（2008 年至 2017 年）。
一家三级医疗中心的内科重症监护病房。
所有在入住 ICU 48 小时内被诊断为脓毒性休克的连续患者均被纳入研究。在 48 小时内出院或死亡的患者被排除在外。
收集 ICU 获得性感染发病前 24 小时内的 RBC、血小板和新鲜冷冻血浆输注数据。
在研究期间，共有 1152 名患者因脓毒性休克入住 ICU，其中 893 名患者在 48 小时的治疗后仍在 ICU 存活。48 小时存活患者中有 28.3%发生了 ICU 获得性感染，其中肺部感染占多数（57%）。发生 ICU 获得性感染的患者更有可能接受 RBC、血小板和新鲜冷冻血浆的输注。在多变量 Cox 因果分析中，血小板输注（因果风险比=1.55[1.09-2.20]；p=0.01）和新鲜冷冻血浆输注（因果风险比=1.38[0.98-1.92]；p=0.05）与 ICU 获得性感染的进一步发生独立相关。
血小板和新鲜冷冻血浆的输注是脓毒性休克患者发生 ICU 获得性感染的危险因素。在未来研究中，应将 ICU 获得性感染的发生作为评估危重病患者输血适应证的一个相关终点。
