[MEDSCAPE新闻频道]:输血的储存期不影响病死率 | 中国病理生理学会危重病医学专业委员会
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[MEDSCAPE新闻频道]:输血的储存期不影响病死率
2017年10月30日 研究点评, 进展交流 暂无评论

Age of Transfused Blood Does Not Affect Mortality

Nicola M. Parry, DVM

September 29, 2017

Transfusing critically ill patients with the freshest available red cells, rather than with standard-issue (oldest available) red cells, provides no clinically meaningful benefits, a new study suggests.

一项新的研究提示,危重病患者输注最新鲜的红细胞而非标准规程(最陈旧的)红细胞并无临床获益。

D. James Cooper, MD, Monash University, Melbourne, Victoria, Australia, and colleagues published the results of the TRANSFUSE trial online September 27 in the New England Journal of Medicine.

9月27日,新英格兰医学杂志在线发表了澳大利亚维多利亚省墨尔本Monash大学的D. James Cooper医生及其同事的TRANSFUSE试验结果。

"The age of transfused red cells did not affect 90-day mortality among critically ill adults," the authors write.

作者写到:“输注红细胞的储存期不影响成年危重病患者的90天病死率。”

To minimize blood disposal, blood banks typically dispense the oldest units of available blood first. However, as red cells age during storage, they undergo biochemical, metabolic, and structural changes that have been referred to as the "storage lesion."

为减少血液的浪费,血库通常首先分发最陈旧的血液。然而,随着红细胞储存期延长,会发生生化、代谢及结构改变,称之为“储存损伤”。

According to the authors, transfusion of older red cells has been associated with a range of adverse effects, including increased morbidity and mortality among critically ill patients.

作者指出,输注较为陈旧的红细胞伴随多种不良反应,包括危重病患者罹患率和病死率增加。

The researchers therefore conducted a multicenter, randomized trial to compare the effect of transfusing the freshest available red cells with that of standard-issue red cells in 4919 high-risk, critically ill patients. The trial took place from November 2012 through December 2016 at 59 centers in five countries.

因此,研究人员进行了一项多中心、随机临床试验,比较输注最新鲜红细胞与标准规程红细胞对4919名高危患者的影响。试验于2012年11月到2016年12月在5个国家59个中心进行。

The researchers randomly assigned 2457 patients to the short-term storage (mean storage duration, 11.8 days) group and 2462 patients to the long-term storage (mean storage duration, 22.4 days) group.

研究人员将2457名患者随机分至短期储存(平均储存期11.8天)组,2462名患者分至长期储存(平均储存期22.4天)组。

The primary outcome was 90-day all-cause mortality.

主要预后终点为90天全因病死率。

At 90 days, 610 patients (24.8%) in the short-term group and 594 (24.1%) in the long-term group had died — an absolute risk difference of 0.7 percentage points (95% confidence interval [CI], –1.7 to 3.1 percentage points), which did not reach statistical significance (P = .57)

至90天时,短期储存组610名患者(24.8%)及长期储存组594名患者(24.1%)死亡—绝对风险差异0.7%(95%可信区间[CI] -1.7 to 3.1%),没有统计学差异(p = .57)。

And at 180 days, the absolute risk difference was 0.4 percentage points (95% CI, –2.1 to 3 percentage points; P = .75).

至180天时,绝对风险差异0.4%(95%可信区间[CI] -2.1 to 3%),没有统计学差异(p = .75)。

For secondary outcomes, more patients in the short-term group experienced febrile nonhemolytic transfusion reactions (5% vs 3.6%; absolute risk difference, 1.4 percentage points; 95% CI, 0.3 - 2.6 percentage points; odds ratio [OR], 1.42; 95% CI, 1.07 - 1.88; P = .01). And the results were similar after adjustment (adjusted OR, 1.45; 95% CI, 1.09 - 1.93; P = .01).

对于次要预后终点,短期储存组更多患者出现发热性非溶血输血反应(5% vs 3.6%;绝对风险差异 ,1.4%;95%CI, 0.3 - 2.6%;比数比[OR],1.42;95%CI 1.07 - 1.88; P = .01)。

However, the study showed no statistically significant differences between the groups for various other secondary outcomes: 28-day mortality (P = .61), rates of persistent organ dysfunction or death at 28 days (P = .39), new bloodstream infections (P = .65), days alive and free of mechanical ventilation (P = .81) or renal-replacement therapy (P = .97) at 28 days. or intensive care unit duration of stay (P = .86).

然而,其他各个次要预后终点两组间并无显著差异:28天病死率(P = .61),28天持续器官功能障碍或死亡(P = .39),新发血行性感染(P = .65),28天内无机械通气存活天数(P = .81)或无肾脏替代治疗存活天数(P = .97),或ICU住院日(P = .86)。

"There was no benefit associated with the freshest available red cells with regard to the primary or secondary outcomes," the authors note, concluding that these findings "support the current international usual practice of transfusing patients with the oldest red cells available."

“输注最新鲜的红细胞对主要或次要预后终点而言并无益处,”作者指出,并得出结论,这些发现“支持目前国际上输注最陈旧红细胞的常见做法。”

"This multicenter study adds a lot of clarity to a topic that hits home for our transfusion medicine community," Justin D. Kreuter, MD, the medical director of Mayo Clinic's Blood Donor Program in Rochester, Minnesota, told Medscape Medical News.

位于明尼苏达州Rochester的Mayo Clinic献血项目医务主任Justin D. Kreuter医生告诉Medscape医学新闻频道:“这项多中心研究阐明了输血医学领域最为重要的问题。”

He emphasized that the current standard practice of issuing blood "first in, first out" ensures that the greatest number of blood donations are transfused. "However, our primary duty is to our patients," he stressed. "This study affirms that our standard practice of issuing oldest blood units, which ensures optimal use of our limited blood inventories, is also best for our patients."

他强调,目前分发血液所采取“先到先用”的标准做法保证了最大量的血液可供输注。“然而,我们的主要任务是服务患者,”他强调说,“这项研究表明,我们分发最陈旧血液的标准做法一方面确保有限的血液资源的合理使用,另一方面对患者而言也是最佳做法”。

He expressed surprise that younger units of blood were associated with significantly more febrile nonhemolytic transfusion reactions. "Although this type of reaction is not fatal, it can be uncomfortable for patients and certainly increases blood wastage," he noted.

他同时对输注新鲜血液显著增加发热性非溶血性输血反应表示意外。“尽管这种反应并不致命,但会引起患者不适,而且造成血液浪费。”他指出。

This study was supported by grants from the Australian National Health and Medical Research Council (NHMRC), the Health Research Council of New Zealand, and the Irish Health Research Board and by funding from the Australian Red Cross Blood Service. During the conduct of this study, five authors reported receiving grant support from the Australian NHMRC, three authors reported receiving grant support from the Health Research Council of New Zealand, one author reported receiving grant support from the Australian Red Cross Blood Service, two authors reported receiving grant support from the Irish Health Research Board, and two authors reported receiving grant support from the Australian National Blood Authority. One author reported receiving nonfinancial support for data collection and investigation from the Australian Red Cross Blood Service. One author also reported being a principal investigator on the INFORM CIHR grant, but not a site investigator role for INFORM. Outside the submitted work, one author reported receiving consulting fees for Eustralis Pharmaceutical Ltd, and another author reported serving as a member of the Blood Service Medical Advisory Committee of the Australian Red Cross Blood Service. The remaining authors have disclosed no relevant financial relationships.

N Engl J Med. Published online September 27, 2017. Abstract

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