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[JAMA Intern Med在线发表]:献血者年龄、性别与接受输血患者的生存率
2017年05月07日 研究点评, 进展交流 暂无评论

Original Investigation

April 24, 2017

Association of Donor Age and Sex With Survival of Patients Receiving Transfusions

Gustaf Edgren, Henrik Ullum, Klaus Rostgaard, et al

JAMA Intern Med. Published online April 24, 2017.

doi:10.1001/jamainternmed.2017.0890

Importance 背景

Following animal model data indicating the possible rejuvenating effects of blood from young donors, there have been at least 2 observational studies conducted with humans that have investigated whether donor age affects patient outcomes. Results, however, have been conflicting.

动物模型提示,年轻献血者可能具有恢复活力的作用。此后,至少有2项观察性研究验证献血者年龄是否影响患者预后。然而,研究结果相互矛盾。

Objective 目的

To study the association of donor age and sex with survival of patients receiving transfusions.

研究献血者年龄、性别与接受输血患者生存率的相关性。

Design, Setting, and Participants 设计,场景与研究人群

A retrospective cohort study based on the Scandinavian Donations and Transfusions database, with nationwide data, was conducted for all patients from Sweden and Denmark who received at least 1 red blood cell transfusion of autologous blood or blood from unknown donors between January 1, 2003, and December 31, 2012. Patients were followed up from the first transfusion until death, emigration, or end of follow-up. Data analysis was performed from September 15 to November 15, 2016.

对斯堪的纳维亚献血与输血数据库中进行的回顾性队列研究。研究对象为2003年1月1日至2012年12月31日间瑞典和丹麦至少输注1个单位红细胞(自体或未知献血者)的所有患者。从首次接受输血开始,随访期至死亡、移居国外或随访期截止。数据分析从2016年9月15日至11月15日。

Exposures 暴露

The number of transfusions from blood donors of different age and sex. Exposure was treated time dependently throughout follow-up.

来自不同年龄与性别献血者的血液输注次数。暴露作为时间依赖变量。

Main Outcomes and Measures 主要预后指标

Hazard ratios (HRs) for death and adjusted cumulative mortality differences, both estimated using Cox proportional hazards regression.

通过Cox比例风险回归模型,计算死亡的风险比(HR)及校正后累积病死率差异。

Results 结果

Results of a crude analysis including 968 264 transfusion recipients (550 257 women and 418 007 men; median age at first transfusion, 73.0 years [interquartile range, 59.8-82.4 years]) showed a U-shaped association between age of the blood donor and recipient mortality, with a nadir in recipients for the most common donor age group (40-49 years) and significant and increasing HRs among recipients of blood from donors of successively more extreme age groups (<20 years: HR, 1.12; 95% CI, 1.10-1.14; ≥70 years: HR, 1.25; 95% CI, 1.08-1.44). Higher mortality was also noted among recipients of blood from female donors (HR, 1.07; 95% CI, 1.07-1.07). Adjustments for number of transfusions with a linear term attenuated the associations, but the increased mortality for recipients of blood from young, old, and female donors was not eliminated. Closer examination of the association between number of transfusions and mortality revealed a nonlinear pattern. After adjustments to accommodate nonlinearity, donor age and sex were no longer associated with patient mortality.

对968 264名接受输血的患者(550 257名女性与 418 007名男性;首次输血时的中位年龄, 73.0岁 [四分位区间, 59.8-82.4 岁]) 进行的分析显示,接受输血者病死率与献血者年龄呈U型相关性,输注来自最常献血年龄组(40-49岁)的血液的患者病死率最低,献血者年龄过小或过大时,患者死亡HR均增加(< 20岁: HR, 1.12; 95% CI, 1.10-1.14; ≥70 岁: HR, 1.25; 95% CI, 1.08-1.44)。献血者为女性时,接受输血患者的病死率更高(HR, 1.07; 95% CI, 1.07-1.07)。对输血次数进行校正后,上述相关性有所减弱,但输注年轻、老年及女性献血者捐献血液的患者病死率仍然增加。输血次数与死亡之间呈非线性相关性。对非线性关系进行校正后,献血者年龄和性别与患者病死率不再相关。

Conclusions and Relevance 结论与意义

Donor age and sex were not associated with patient survival and need not be considered in blood allocation. Any comparison between common and less common categories of transfusions will inevitably be confounded by the number of transfusions, which drives the probability of receiving the less common blood components. Previous positive findings regarding donor age and sex are most likely explained by residual confounding.

献血者年龄和性别与患者生存率并不相关,在分配血液时无需考虑这些因素。对于输血的常见与不常见分组之间进行的任何比较,均不可避免地受到输血次数的混杂影响,这可能造成输注不常见血液成分的可能性增加。既往有关献血者年龄和性别的阳性研究结果很可能受到残余混杂因素的影响。

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