Обзор американских кардиологических журналов за неделю (ссылки)

[Chevychelov]

Title: Duration of Red Cell Storage Before Transfusion and In-Hospital Mortality
Topic: General Cardiology
Date Posted: 6/10/2010
Author(s): Eikelboom JW, Cook RJ, Liu Y, Huddle NM.
Citation: Am Heart J 2010;159:737-743.
Clinical Trial: No
Study Question: What is the association between duration of pretransfusion storage of red cells and in-hospital mortality?
Methods: The authors used multivariable Cox regression modeling with time-dependent stratification to assess the effect of age of transfused red blood cells on risk of in-hospital mortality in a registry of consecutive patients admitted to an acute care facility with a major diagnosis of cardiovascular disease. The primary outcome was in-hospital mortality.
Results: Four thousand nine hundred thirty-three consecutive patients with a major diagnosis of cardiovascular disease admitted to acute care facilities in Hamilton, Canada, received 21,435 units of red cells. The median number of units received was 3 (interquartile range 2-5), and the median age of transfused blood was 17 (interquartile range 13-22) days. After adjustment for demographics, clinical characteristics, and time-dependent covariates and stratification by the number of units transfused, the relative risk for death was 1.02 for every 1-day increase in maximum age of blood. The adjusted relative risk for death increased with each increasing quartile of maximum age of blood, with patients in the highest quartile having a relative risk for death of 1.48 (95% confidence interval, 1.07-2.05) compared with those in the lowest (reference) quartile.
Conclusions: The authors concluded that in hospitalized patients with a major diagnosis of cardiovascular disease, there is a modest independent association between increasing duration of storage of red cells and risk of in-hospital mortality.
Perspective: This study suggests a modest independent association between increasing maximum age of red cells and risk of in-hospital mortality in patients with a major diagnosis of cardiovascular disease. The results should prompt research to develop improved methods of red cell storage, rejuvenation, and delivery. Further studies of the effect of age of red blood cells on mortality are also needed to accurately quantify the risk in other patient populations and explore the mechanisms of the association. Meanwhile, it would seem logical to develop regional and national networks to study how transfusion is currently being used and how to make it safer by reserving transfusions only for occasions in which clinical evidence demonstrates that the overall benefit of blood transfusions outweighs the potential risks. Debabrata Mukherjee, M.D., F.A.C.C.