Lehr Anab Rebecca, Hébert Paul, Fergusson Dean, Sabri Elham, Lacroix Jacques
Department of Pediatrics, Montreal Children Hospital, McGill University, Montreal, QC, Canada.
Department of Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada.
Crit Care Med. 2023 Mar 1;51(3):e73-e80. doi: 10.1097/CCM.0000000000005775. Epub 2022 Dec 27.
The Age of Blood Evaluation (ABLE) study reported no clinical benefit in fresher compared with standard delivery RBC units (length of storage: 6.9 ± 4.1 vs 22.0 ± 8.4 d, respectively). Perioperative patients are often anemic, at risk of blood loss, and more exposed to RBC transfusions. We address the question whether fresh RBC units are safer than standard delivery RBC units in perioperative ICU patients.
Subgroup analysis of surgical nontrauma adults enrolled in the ABLE randomized controlled trial.
ICUs.
Three hundred twenty surgical patients among the 2,510 ICU adults recruited in the ABLE study who had a request for a first RBC transfusion in the first week in ICU stay and an anticipated length of mechanical ventilation greater than or equal to 48 hours. We included perioperative patients but excluded elective cardiac surgery and trauma.
Surgical participants were allocated to receive either RBC units stored less than or equal to 7 days or standard issue RBC.
The primary outcome was 90-day all-cause mortality. One hundred seventy-two perioperative patients were allocated to the fresh and 148 to the standard group. Baseline data were similar. The length of storage was 7.2 ± 6.4 in fresh and 20.6 ± 8.4 days in standard group ( p < 0.0001). The 90-day mortality was 29.7% and 28.4%, respectively (absolute risk difference: 0.01; 95% CI -0.09 to 0.11; p = 0.803). No significant differences were observed for all secondary outcomes, including 6-month mortality, even after adjustment for age, country, and Acute Physiology and Chronic Health Evaluation score.
There was no evidence that fresh red cells improved outcomes as compared to standard issue red cells in critically ill surgical patients, consistent with other patients enrolled in the ABLE trial.
血液评估时代（ABLE）研究报告称，与标准保存期的红细胞单位相比，保存期更新鲜的红细胞单位并无临床益处（保存期分别为：6.9±4.1天和22.0±8.4天）。围手术期患者常伴有贫血，有失血风险，且更常接受红细胞输血。我们探讨在围手术期重症监护病房（ICU）患者中，新鲜红细胞单位是否比标准保存期的红细胞单位更安全。
对参与ABLE随机对照试验的非创伤性手术成年患者进行亚组分析。
重症监护病房。
在ABLE研究招募的2510名ICU成年患者中，有320名手术患者，他们在入住ICU的第一周首次要求输注红细胞，且预计机械通气时间大于或等于48小时。我们纳入了围手术期患者，但排除了择期心脏手术和创伤患者。
手术参与者被分配接受保存期小于或等于7天的红细胞单位或标准发放的红细胞。
主要结局为90天全因死亡率。172名围手术期患者被分配到新鲜组，148名被分配到标准组。基线数据相似。新鲜组的保存期为7.2±6.4天，标准组为20.6±8.4天（p<0.0001）。90天死亡率分别为29.7%和28.4%（绝对风险差异：0.01；95%CI -0.09至0.11；p = 0.803）。即使在对年龄、国家和急性生理与慢性健康状况评分进行调整后，包括6个月死亡率在内的所有次要结局均未观察到显著差异。
与标准发放的红细胞相比，没有证据表明新鲜红细胞能改善重症手术患者的预后，这与ABLE试验中的其他患者一致。
