The association between the transfusion of older blood and outcomes after trauma - PubMed (original) (raw)

The association between the transfusion of older blood and outcomes after trauma

Monique Hassan et al. Shock. 2011 Jan.

Abstract

Allogeneic packed red blood cells (PRBCs) suppress immunity and influence outcomes. The influence of blood on the risk of infection and death may be related to the duration of storage. We sought to determine whether blood storage duration was associated with infection or death in a large cohort of injury victims. We reviewed a cohort of trauma patients transfused at least 1 U of PRBCs within 24 h of admission to a level 1 trauma center. The outcomes of interest were complicated sepsis and mortality. We compared the amount of older blood (>14 days storage) given to patients who did or did not develop the outcomes of interest using univariate and multivariate methods. A total of 820 patients were included. Patients who died (n = 117) received more units of older blood than those who lived (5 U [inter quartile range {IQR}, 2-9] vs. 3 U [IQR, 2-6]; P < 0.001). Patients with complicated sepsis (n = 244) received a greater volume of older blood than those without complicated sepsis (6 U [IQR, 2-10] vs. 3 U [IQR, 1-5]; P < 0.001). After adjusting for clinical factors, including the total amount of blood transfused, patients receiving greater than or equal to 7 U of older blood had a higher risk of complicated sepsis than patients receiving 1 or fewer units (odds ratio, 1.9; P = 0.03). The risk for complicated sepsis and death in trauma victims who are transfused blood is high. The amount of older blood transfused is associated with complicated sepsis. Although the best strategy to minimize the effects of allogeneic blood is to avoid unnecessary transfusions, it may be particularly important to avoid transfusing multiple units of older blood.

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Figures

Figure 1

Figure 1. Study subject inclusion

1,958 patients were enrolled and of those, 820 received at least one unit of PRBCs during the 1st 24 hours of admission. These patients were then analyzed for outcomes of interest – complicated sepsis and death. All blood transfused during the hospitalization was analyzed.

Figure 2

Figure 2. Units of blood transfused and day of sepsis onset

Shown in this figure are the total number of units of PRBCs transfused (left y-axis) and the number of patients diagnosed with sepsis (right y-axis) on each post-injury day (x-axis).

Figure 3

Figure 3. Mortality and infection outcome for entire cohort

Figure 3a: Patients who died received significantly more units overall as well as a greater number of units of older blood. (p < 0.001 for total transfusions and p = 0.004 for older blood, both by Mann-Whitney-U test). Figure 3b: Similarly, patients who developed complicated sepsis received more blood overall and more units of older blood. (p < 0.001 for total PRBCs and p = 0.004 for older blood by Mann-Whitney-U test)

Figure 3

Figure 3. Mortality and infection outcome for entire cohort

Figure 3a: Patients who died received significantly more units overall as well as a greater number of units of older blood. (p < 0.001 for total transfusions and p = 0.004 for older blood, both by Mann-Whitney-U test). Figure 3b: Similarly, patients who developed complicated sepsis received more blood overall and more units of older blood. (p < 0.001 for total PRBCs and p = 0.004 for older blood by Mann-Whitney-U test)

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References

    1. Moore FA, Moore EE, Sauaia A. Blood Transfusion. An Independent Risk Factor for Postinjury Multiple Organ Failure. Arch.Surg. 1997;132(6):620–624. - PubMed
    1. Croce MA, Tolley EA, Claridge JA, Fabian TC. Transfusions Result in Pulmonary Morbidity and Death After a Moderate Degree of Injury. J.Trauma. 2005;59(1):19–23. - PubMed
    1. Hensler T, Heinemann B, Sauerland S, Lefering R, Bouillon B, Andermahr J, Neugebauer EA. Immunologic Alterations Associated With High Blood Transfusion Volume After Multiple Injury: Effects on Plasmatic Cytokine and Cytokine Receptor Concentrations. Shock. 2003;20(6):497–502. - PubMed
    1. Stadler I, Toumbis CA, Ambrus JL. Influence of Cold Storage Altered Red Cell Surface on the Function of Platelets. J.Med. 1994;25(6):353–361. - PubMed
    1. Berezina TL, Zaets SB, Morgan C, Spillert CR, Kamiyama M, Spolarics Z, Deitch EA, Machiedo GW. Influence of Storage on Red Blood Cell Rheological Properties. J.Surg.Res. 2002;102(1):6–12. - PubMed

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