Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Indian J Pediatr. 2021 Oct;88(10):985-990. doi: 10.1007/s12098-021-03740-6. Epub 2021 Apr 17.
To study the clinical outcomes of red blood cell (RBC) transfusion practices in critically ill children.
This prospective cohort study was conducted in a tertiary care pediatric intensive care unit (PICU) from March-2015 to January-2018. Inverse probability of treatment weighting (IPTW) using propensity score analysis was used. Children aged 1 mo to 12 y admitted to the PICU were screened. Patients were classified into 'transfused' and 'nontransfused', based on whether they received a transfusion or not. Patients with hematological malignancies, or immunosuppressant drugs, or those who received repeated transfusions, or received transfusion before admission, or died within 24 h were excluded. The primary outcome was all-cause 28 d mortality. Secondary outcomes were new-onset organ dysfunction, mechanical ventilation duration, and length of PICU and hospital stay.
A total of 1014 patients [transfused = 277; nontransfused = 737) were included. In IPTW analysis, the risk of all-cause 28 d mortality was 53% higher in transfused than nontransfused patients [hazard ratio = 1.53, 95% CI: 1.18-1.98, p = 0.001 by Log-rank test]. Organ dysfunction was higher in transfused than nontransfused patients [3.8% vs. 1.3%, hazard ratio = 3.0, 95% CI: 1.40-6.48, p = 0.005]. The risk of staying in the mechanical ventilation was similar in both groups [hazard ratio = 1.03, 95% CI: 0.86-1.23, p = 0.756]. The risk of extended stay in the PICU and hospital was 16% and 21% higher in transfused than nontransfused patients [hazard ratio = 1.16, 95% CI: 1.03-1.30; p = 0.005; and 1.21, 95% CI: 1.08-1.36; p = 0.001], respectively.
Red blood cell transfusion was independently associated with higher all-cause 28 d mortality and morbidities in critically ill children.
研究危重症患儿红细胞（RBC）输血治疗的临床结局。
本前瞻性队列研究于 2015 年 3 月至 2018 年 1 月在一家三级儿童重症监护病房（PICU）进行。采用倾向评分分析的逆概率处理加权法（IPTW）。筛选出年龄在 1 个月至 12 岁之间入住 PICU 的患儿。根据患儿是否接受输血，将其分为“输血”和“未输血”两组。排除患有血液系统恶性肿瘤或使用免疫抑制剂的患儿，或接受多次输血、入院前已接受输血或入院 24 小时内死亡的患儿。主要结局为全因 28 天死亡率。次要结局为新发器官功能障碍、机械通气时间、PICU 和住院时间。
共纳入 1014 例患儿[输血组 277 例；未输血组 737 例]。在 IPTW 分析中，输血组患儿全因 28 天死亡率较未输血组高 53%[风险比（HR）=1.53，95%可信区间（CI）：1.18-1.98，p=0.001（对数秩检验）]。输血组患儿器官功能障碍发生率高于未输血组[3.8%比 1.3%，HR=3.0，95%CI：1.40-6.48，p=0.005]。两组患儿机械通气时间风险比相似[HR=1.03，95%CI：0.86-1.23，p=0.756]。输血组患儿 PICU 和住院时间分别延长 16%和 21%[HR=1.16，95%CI：1.03-1.30，p=0.005；HR=1.21，95%CI：1.08-1.36，p=0.001]。
红细胞输血与危重症患儿全因 28 天死亡率和并发症发生率升高独立相关。
