Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Surgery. 2024 Mar;175(3):885-892. doi: 10.1016/j.surg.2023.08.038. Epub 2023 Oct 16.
The critical blood shortage in January 2022 threatened the availability of blood. Utility of transfusion per unit was reported in a previous study, revealing patients receiving balanced transfusion are more likely to die after 16 units of packed red blood cells. We aimed to validate this study using a larger database.
Retrospective analysis utilizing the American College of Surgeons Trauma Quality Improvement Program was performed. Trauma patients aged ≥16 receiving transfusion within 4 hours of arrival were included and excluded if they died in the emergency department, received <2 units of packed red blood cells, did not receive fresh frozen plasma, or were missing data. Primary outcome was mortality. Subgroups were balanced transfusion if receiving ≤2:1 ratio of packed red blood cells:fresh frozen plasma, and unbalanced transfusion if >2:1 ratio.
A total of 17,047 patients were evaluated with 28% mortality (4,822/17,408). Multivariable logistic regression identified advancing age (odds ratio 1.03 95% confidence interval 1.03-1.04), higher ISS (odds ratio 1.04, 95% confidence interval 1.03-1.04), and lower GCS (odds ratio 0.82, 95% confidence interval 0.82-0.83) as risk factors for mortality. Protective factors were balanced transfusion (odds ratio 0.81 95% confidence interval 0.71-0.93), male sex (odds ratio 0.90, 95% confidence interval 0.81-0.99), and blunt mechanism (odds ratio 0.74, 95% confidence interval 0.67-0.81). At 11 units of packed red blood cells, balanced transfusion patients were more likely to die (odds ratio 0.88, 95% confidence interval 0.80-0.98). Balanced transfusion patients survived at a higher rate for each unit of packed red blood cells, between 6 and 23 units of packed red blood cells.
Mortality increases with each unit of packed red blood cell transfused. At 11 units of packed red blood cells, mortality is the more likely outcome. Balanced transfusion improves the chance of survival through 23 units of packed red blood cells.
2022 年 1 月，血液严重短缺，危及血液供应。之前的研究报告了每单位输血的使用情况，结果显示，接受平衡输血的患者在输注 16 单位红细胞后更有可能死亡。我们旨在使用更大的数据库验证这项研究。
利用美国外科医师学会创伤质量改进计划进行回顾性分析。纳入年龄≥16 岁、在入院后 4 小时内接受输血的创伤患者，如果他们在急诊科死亡、接受<2 单位红细胞、未接受新鲜冰冻血浆或数据缺失，则排除在外。主要结局为死亡率。如果接受红细胞：新鲜冰冻血浆的比例≤2:1，则为平衡输血，比例>2:1 则为非平衡输血。
共评估了 17047 例患者，死亡率为 28%（4822/17408）。多变量逻辑回归确定年龄增长（优势比 1.03，95%置信区间 1.03-1.04）、ISS 升高（优势比 1.04，95%置信区间 1.03-1.04）和 GCS 降低（优势比 0.82，95%置信区间 0.82-0.83）为死亡的危险因素。保护因素为平衡输血（优势比 0.81，95%置信区间 0.71-0.93）、男性（优势比 0.90，95%置信区间 0.81-0.99）和钝性机制（优势比 0.74，95%置信区间 0.67-0.81）。在输注 11 单位红细胞时，平衡输血患者更有可能死亡（优势比 0.88，95%置信区间 0.80-0.98）。平衡输血患者在输注每单位红细胞后存活的可能性更高，在输注 6 至 23 单位红细胞时均如此。
随着每单位红细胞的输注，死亡率增加。在输注 11 单位红细胞时，更有可能出现死亡。通过输注 23 单位红细胞，平衡输血提高了生存机会。
