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[JAMA发表论文]: 献血者性别及既往妊娠史与接受输血者病死率的相关性
2019年06月16日 时讯速递, 进展交流 暂无评论

Original Investigation June 11, 2019

Association of Blood Donor Sex and Prior Pregnancy With Mortality Among Red Blood Cell Transfusion Recipients

Gustaf Edgren Edward L. Murphy, Don J. Brambilla, et al

JAMA. 2019;321(22):2183-2192. doi:10.1001/jama.2019.7084

Abstract 摘要

Importance 背景

Evidence regarding associations of blood donor sex with mortality among red blood cell transfusion recipients is conflicting.

有关献血者性别与接受输血者病死率相关关系的证据相互矛盾。

Objective 目的

To study associations of donor sex and prior pregnancy with mortality of transfusion recipients.

研究献血者性别及既往妊娠史与接受输血者病死率的相关性

Design, Setting, and Participants 试验设计,场景及研究人群

Data from 3 retrospective cohorts of transfusion recipients (the Kaiser Permanente Northern California [KPNC] and Recipient Epidemiology and Donor Evaluation Study-III [REDS-III] databases of data from January 2013 to December 2016 and the Scandinavian Donations and Transfusions [SCANDAT] database with data from January 2003 to December 2012) were analyzed. Final dates of follow-up were December 31, 2016, for the KPNC and REDS-III cohorts and December 31, 2012, for the SCANDAT cohort. Stratified Cox regression models were used to estimate associations between donor exposure groups with risk of mortality, adjusting for the number of red blood cell unit transfusions.

数据来自接受输血患者的3个回顾性队列(Kaiser Permanente Northern California [KPNC] 及 Recipient Epidemiology and Donor Evaluation Study-III [REDS-III] 数据库从2013年1月至2016年12月的资料,Scandinavian Donations and Transfusions [SCANDAT] 数据库从2003年1月至2012年12月的资料)。

Exposures 暴露因素

The number of transfused red blood cell units from female donors, previously pregnant donors, and sex-discordant donors (male donor and female recipient or female donor and male recipient).

来自女性献血者、既往妊娠史的献血者以及不同性别献血者(男性献血者及女性输血者,或女性献血者及男性输血者)输血单位数

Main Outcomes and Measures 主要预后指标

In-hospital mortality.

住院病死率

Results 结果

The study population included 34 662 patients (mean age, 69 years; 18 652 [54%] women) from the KPNC cohort, 93 724 patients (mean age, 61 years; 48 348 [52%] women) from the REDS-III cohort, and 918 996 patients (mean age, 72 years; 522 239 [57%] women) from the SCANDAT cohort. The median number of red blood cell transfusions per patient was 3 in the KPNC cohort, 2 in the REDS-III cohort, and 3 in the SCANDAT cohort. The percentage of transfusions from previously pregnant or parous donors was 9% in the KPNC cohort, 18% in the REDS-III cohort, and 25% in the SCANDAT cohort. The percentage of transfusions in the 3 cohorts from female donors ranged from 39% to 43%, from previously pregnant or parous donors ranged from 9% to 25%, and from sex-discordant donors ranged from 44% to 50%. There were 3217 in-hospital deaths in the KPNC cohort, 8519 in the REDS-III cohort, and 198 537 in the SCANDAT cohort. There were no statistically significant associations between any of the 3 donor exposures and in-hospital mortality in the 3 cohorts. Hazard ratios for in-hospital mortality per transfused unit from female donors were 0.99 (95% CI, 0.96-1.03) for the KPNC cohort, 1.00 (95% CI, 0.99-1.01) for the REDS-III cohort, and 1.00 (95% CI, 0.99-1.00) for the SCANDAT cohort. For units from previously pregnant or parous female donors, hazard ratios were 1.00 (95% CI, 1.00-1.01) for the KPNC cohort, 1.01 (95% CI, 0.98-1.03) for the REDS-III cohort, and 1.00 (95% CI, 1.00-1.01) for the SCANDAT cohort. For units from sex-discordant transfusions, hazard ratios were 1.02 (95% CI, 0.99-1.05) for the KPNC cohort, 0.99 (95% CI, 0.98-1.00) for the REDS-III cohort, and 1.00 (95% CI, 0.99-1.00) for the SCANDAT cohort.

研究人群包括来自KPNC队列的34 662名患者(平均年龄, 69岁; 18 652 [54%]名女性),来自REDS-III队列的93 724名患者(平均年龄, 61岁; 48 348 [52%]名女性),以及来自SCANDAT队列的918 996名患者(平均年龄, 72岁; 522 239 [57%]名女性)。每名患者输注红细胞的中位数为 KPNC 队列3个单位,REDS-III队列2个单位,SCANDAT队列3个单位。来自既往妊娠史献血者的输血比例分别为KPNC队列9%,REDS-III队列18%,SCANDAT队列25%。3个队列中来自女性献血者的输血比例从39% 到 43%,来自既往妊娠史献血者的输血比例从 9% 到 25%,不同性别献血者的比例从44% 到 50%。KPNC队列患者中3217名住院期间死亡, cohort, 8519 in the REDS-III和 SCANDAT队列分别有8519名和198537名患者住院期间死亡。在3个队列中,上述3种献血者暴露史与住院病死率之间没有显著相关性。每输注来自女性献血者一个单位红细胞的住院死亡风险比为KPNC队列 0.99 (95% CI, 0.96-1.03),REDS-III队列1.00 (95% CI, 0.99-1.01),SCANDAT队列1.00 (95% CI, 0.99-1.00)。输注来自既往妊娠史献血者的每个单位红细胞,死亡风险比分别为KPNC队列 1.00 (95% CI, 1.00-1.01),REDS-III队列1.01 (95% CI, 0.98-1.03),SCANDAT队列1.00 (95% CI, 1.00-1.01)。输注来自不同性别献血者的每个单位红细胞,死亡风险比分别为 KPNC队列1.02 (95% CI, 0.99-1.05),REDS-III队列0.99 (95% CI, 0.98-1.00),SCANDAT队列1.00 (95% CI, 0.99-1.00)。

Conclusions and Relevance 结论与意义

Among red blood cell transfusion recipients, transfusions from female, previously pregnant, or sex-discordant donors were not significantly associated with increased mortality.

输注来自女性、既往妊娠史或不同性别献血者的红细胞与接受输血者病死率无显著相关。

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