Baysan M, Hilderink B, van Manen L, Caram-Deelder C, Mik E G, Juffermans N P, van der Bom J G, Arbous M S
Department of Intensive Care Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Intensive Care Med Exp. 2024 Jul 8;12(1):61. doi: 10.1186/s40635-024-00646-3.
Currently, there is no marker of efficacy of red blood cell (RBC) transfusion. This study describes the impact of RBC transfusion on mitochondrial oxygen tension (mitoPO) and mitochondrial oxygen consumption (mitoVO) in critically ill patients with anemia.
Critically ill patients with a hemoglobin concentration < 10 g/dL, for whom a single RBC unit had been ordered, were included. MitoPO was measured with the COMET device immediately before RBC transfusion, 0.5 h, 1 h, 3 h, and 24 h after RBC transfusion. MitoVO was calculated from dynamic mitoPO measurements during cessation of local oxygen supply.
Sixty-three patients participated, median age 64.0 (interquartile range (IQR) 52.3-72.8) years, median hemoglobin concentration before transfusion 7.4 (IQR 7.1-7.7) g/dL. Median mitoPO values were 55.0 (IQR 49.6-63.0) mmHg before RBC transfusion, 51.0 (IQR 41.5-61.2) directly after and 67.3 (IQR 41.6-83.7) at 24 h after RBC transfusion. Median mitoVO values were 3.3 (IQR 2.1-5.9) mmHg/s before RBC transfusion, 3.7 (IQR 2.0-5.1) mmHg/s directly after, and 3.1 (IQR 2.5-4.8) mmHg/s 24 h after RBC transfusion. In the higher Hb concentration group (> 7 g/dL), we saw a dissociation of the effect of RBC transfusion on mitoPO versus on mitoVO values. MitoPO and mitoVO values were not associated with commonly used parameters of tissue perfusion and oxygenation.
RBC transfusion did not alter mitoPO and mitoVO in critically ill patients with anemia. MitoPO and mitoVO values were not notably associated with Hb concentrations, parameters of severity of illness and markers of tissue perfusion or oxygenation. Given the high baseline value, it cannot be excluded nor confirmed whether RBC can improve low mitoPO. Trial registration number NCT03092297 (registered 27 March 2017).
目前，尚无红细胞（RBC）输血疗效的标志物。本研究描述了RBC输血对贫血重症患者线粒体氧张力（mitoPO）和线粒体氧消耗（mitoVO）的影响。
纳入血红蛋白浓度<10 g/dL且已医嘱输注单个RBC单位的重症患者。在RBC输血前、输血后0.5小时、1小时、3小时和24小时，使用COMET设备测量mitoPO。mitoVO通过局部氧气供应停止期间的动态mitoPO测量值计算得出。
63例患者参与研究，中位年龄64.0（四分位间距（IQR）52.3 - 72.8）岁，输血前中位血红蛋白浓度7.4（IQR 7.1 - 7.7）g/dL。RBC输血前mitoPO中位值为55.0（IQR 49.6 - 63.0）mmHg，输血后即刻为51.0（IQR 41.5 - 61.2）mmHg，输血后24小时为67.3（IQR 41.6 - 83.7）mmHg。RBC输血前mitoVO中位值为3.3（IQR 2.1 - 5.9）mmHg/s，输血后即刻为3.7（IQR 2.0 - 5.1）mmHg/s，输血后24小时为3.1（IQR 2.5 - 4.8）mmHg/s。在较高血红蛋白浓度组（>7 g/dL）中，我们观察到RBC输血对mitoPO和mitoVO值的影响存在分离。mitoPO和mitoVO值与常用的组织灌注和氧合参数无关。
RBC输血未改变贫血重症患者的mitoPO和mitoVO。mitoPO和mitoVO值与血红蛋白浓度、疾病严重程度参数以及组织灌注或氧合标志物无显著关联。鉴于基线值较高，无法排除也无法证实RBC是否能改善低mitoPO。试验注册号NCT03092297（2017年3月27日注册）。
