Karameh Hani, Bruoha Sharon, Taha Louay, Tabi Meir, Farkash Rivka, Karmi Mohammad, Hamayel Kamal, Perel Nimrod, Steinmetz Yoed, Marmor David, Manassra Mohammed, Maller Tomer, Hitter Rafael, Amsalem Itshak, Glikson Michael, Asher Elad
Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel.
Department of Cardiology, Barzilai Medical Center, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
J Clin Med. 2023 Feb 7;12(4):1304. doi: 10.3390/jcm12041304.
Acutely ill patients treated with blood transfusion (BT) have unfavorable prognoses. Nevertheless, data regarding outcomes in patients treated with BT admitted into a contemporary tertiary care medical center intensive cardiac care unit (ICCU) are limited. The current study aimed to assess the mortality rate and outcomes of patients treated with BT in a modern ICCU.
Prospective single center study where we evaluated mortality, in the short and long term, of patients treated with BT between the period of January 2020 and December 2021 in an ICCU.
A total of 2132 consecutive patients were admitted to the ICCU during the study period and were followed-up for up to 2 years. In total, 108 (5%) patients were treated with BT (BT-group) during their admission, with 305 packed cell units. The mean age was 73.8 ± 14 years in the BT-group vs. 66.6 ± 16 years in the non-BT (NBT) group, < 0.0001. Females were more likely to receive BT as compared with males (48.1% vs. 29.5%, respectively, < 0.0001). The crude mortality rate was 29.6% in the BT-group and 9.2% in the NBT-group, < 0.0001. Multivariate Cox analysis found that even one unit of BT was independently associated with more than two-fold the mortality rate [HR = 2.19 95% CI (1.47-3.62)] as compared with the NBT-group, < 0.0001]. Receiver operating characteristic (ROC) curve was plotted for multivariable analysis and showed area under curve (AUC) of 0.8 [95% CI (0.760-0.852)].
BT continues to be a potent and independent predictor for both short- and long-term mortality even in a contemporary ICCU, despite the advanced technology, equipment and delivery of care. Further considerations for refining the strategy of BT administration in ICCU patients and guidelines for different subsets of high-risk patients may be warranted.
接受输血（BT）治疗的危重病患者预后不佳。然而，关于当代三级医疗中心重症心脏监护病房（ICCU）收治的接受BT治疗患者的预后数据有限。本研究旨在评估现代ICCU中接受BT治疗患者的死亡率和预后情况。
前瞻性单中心研究，我们评估了2020年1月至2021年12月期间在ICCU接受BT治疗患者的短期和长期死亡率。
研究期间共有2132例连续患者入住ICCU，并随访长达2年。总共有108例（5%）患者在住院期间接受了BT治疗（BT组），共输注305个红细胞单位。BT组的平均年龄为73.8±14岁，非BT（NBT）组为66.6±16岁，P<0.0001。与男性相比，女性接受BT治疗的可能性更大（分别为48.1%和29.5%，P<0.0001）。BT组的粗死亡率为29.6%，NBT组为9.2%，P<0.0001。多变量Cox分析发现，与NBT组相比，即使输注一个单位的BT也与死亡率增加两倍以上独立相关[风险比（HR）=2.19，95%置信区间（CI）（1.47 - 3.62）]，P<0.0001]。绘制受试者工作特征（ROC）曲线进行多变量分析，曲线下面积（AUC）为0.8[95%CI（0.760 - 0.852）]。
即使在拥有先进技术、设备和护理的当代ICCU中，BT仍然是短期和长期死亡率的有力且独立的预测指标。可能需要进一步考虑完善ICCU患者BT管理策略以及针对不同高危患者亚组的指南。
