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[NEJM在线发表]:输注红细胞的储存期不影响成年危重病患者预后
2017年10月11日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults

D. James Cooper, M.D., Zoe K. McQuilten, Ph.D., Alistair Nichol, Ph.D., Bridget Ady, M.Clin.Res.Meth., Cécile Aubron, Ph.D., Michael Bailey, Ph.D., Rinaldo Bellomo, M.D., Dashiell Gantner, M.B., B.S., David O. Irving, Ph.D., Kirsi-Maija Kaukonen, Ph.D., Colin McArthur, M.B., Ch.B., Lynne Murray, B.App.Sci., Ville Pettilä, Ph.D., and Craig French, M.B., B.S., for the TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group

N Engl J Med September 27, 2017

DOI: 10.1056/NEJMoa1707572

BACKGROUND 背景

It is uncertain whether the duration of red-cell storage affects mortality after transfusion among critically ill adults.

尚不明确红细胞储存期是否影响成年危重病患者输血后病死率

METHODS 方法

In an international, multicenter, randomized, double-blind trial, we assigned critically ill adults to receive either the freshest available, compatible, allogeneic red cells (short-term storage group) or standard-issue (oldest available), compatible, allogeneic red cells (long-term storage group). The primary outcome was 90-day mortality.

这是一项国际多中心随机双盲临床试验。我们将成年危重病患者分为输注最新鲜的血型相合异体红细胞(短期储存组)或标准操作(最陈旧)的血型相合异体红细胞(长期储存组)。主要预后终点为90天病死率。

RESULTS 结果

From November 2012 through December 2016, at 59 centers in five countries, 4994 patients underwent randomization and 4919 (98.5%) were included in the primary analysis. Among the 2457 patients in the short-term storage group, the mean storage duration was 11.8 days. Among the 2462 patients in the long-term storage group, the mean storage duration was 22.4 days. At 90 days, there were 610 deaths (24.8%) in the short-term storage group and 594 (24.1%) in the long-term storage group (absolute risk difference, 0.7 percentage points; 95% confidence interval [CI], −1.7 to 3.1; P=0.57). At 180 days, the absolute risk difference was 0.4 percentage points (95% CI, −2.1 to 3.0; P=0.75). Most of the prespecified secondary measures showed no significant between-group differences in outcome.

从2012年11月至2016年12月,在5个国家59个中心,共有4994名患者接受随机分组,4919名(98.5%)纳入主要分析。在短期储存组2457名患者中,平均储存期为11.8天。在长期储存组2462名患者中,平均储存期为22.4天。90天时,短期储存组610名(24.8%)患者死亡,长期储存组594名(24.1%)患者死亡(绝对风险差异,0.7%;95%可信区间[CI] -1.7 to 3.1;p = 0.57)。至180天时,绝对风险差异为0.45% (95% CI, −2.1 to 3.0; P=0.75)。多数预先确定的次要预后指标没有明显的组间差异。

CONCLUSIONS 结论

The age of transfused red cells did not affect 90-day mortality among critically ill adults. (Funded by the Australian National Health and Medical Research Council and others; TRANSFUSE Australian and New Zealand Clinical Trials Registry number, ACTRN12612000453886; ClinicalTrials.gov number, NCT01638416.)

输注红细胞的储存期不影响成年危重病患者90天病死率。

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