Crit Care. 2011;15(2):R116. doi: 10.1186/cc10142. Epub 2011 Apr 15.
Age of red blood cells and mortality in the critically ill.
Pettilä V,
Westbrook AJ,
Nichol AD,
Bailey MJ,
Wood EM,
Syres G,
Phillips LE,
Street A,
French C,
Murray L,
Orford N,
Santamaria JD,
Bellomo R,
Cooper DJ;
Blood Observational Study Investigators for ANZICS Clinical Trials Group.
Cooper DJ, Nichol A, Street A, Vallance S, McArthur C, McGuiness S, Newby L, Simmonds C, Parke R, Buhr H, Bellomo R, Goldsmith D, O'Sullivan K, Mercer I, Gazzard R, Tauschke C, Hill D, Fletcher J, Boschert C, Koch G, Ernest D, Eliott S, Howe B, Hawker F, Ellem K, Duff K, Henderson S, Mehrtens J, Milliss D, Wong H, Arora S, O'Bree B, Shepherd K, Ihle B, Ho S, Ihle B, Graan M, Bernsten A, Ryan E, Botha J, Vuat J, Orford N, Kinmonth A, Fraser M, Richards B, Tallott M, Whitbread R, Freebairn R, Anderson A, Parr M, Micallef S, Deshpande K, Wood J, Williams T, Tai J, Boase A, Arora S, Galt P, King B, Price R, Tomlinson J, Cole L, Seppelt I, Weisbrodt L, Gresham R, Nikas M, Laing J, Bell J, McHugh G, Hancock D, Kirkman S, Shehabi Y, Campbell M, Stockdale V, Peake S, Williams P, Sharley P, O'Connor S, Stephens D, Thomas J, Sistla R, McAllister R, Marsden K, MacIsaac C, Barge D, Caf T, Finfer S, Tan L, Bird S, Webb S, Chamberlain J, McEntaggart G, Gould A, Totaro R, Rajbhandari D, Baker S, Roberts B, Lavercombe P, Walker R, Myburgh J, Dhiacou V, Santamaria J, Smith R, Holmes J, Nair P, Burns C, Browne T, Goodson J, van Haren F, La Pine M, Hart G, Broadbent J, Hicks P, Mackle D, Andrews L, French C, Raunow H, Keen L, Davey-Quinn A, Hill F, Xu R.
Source
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Commercial Road, Melbourne 3004, Victoria, Australia. ville.pettila@hus.fi
Abstract
INTRODUCTION:
In critically ill patients, it is uncertain whether exposure to older red blood cells (RBCs) may contribute to mortality. We therefore aimed to evaluate the association between the age of RBCs and outcome in a large unselected cohort of critically ill patients in Australia and New Zealand. We hypothesized that exposure to even a single unit of older RBCs may be associated with an increased risk of death.
METHODS:
We conducted a prospective, multicenter observational study in 47 ICUs during a 5-week period between August 2008 and September 2008. We included 757 critically ill adult patients receiving at least one unit of RBCs. To test our hypothesis we compared hospital mortality according to quartiles of exposure to maximum age of RBCs without and with adjustment for possible confounding factors.
RESULTS:
Compared with other quartiles (mean maximum red cell age 22.7 days; mortality 121/568 (21.3%)), patients treated with exposure to the lowest quartile of oldest RBCs (mean maximum red cell age 7.7 days; hospital mortality 25/189 (13.2%)) had an unadjusted absolute risk reduction in hospital mortality of 8.1% (95% confidence interval = 2.2 to 14.0%). After adjustment for Acute Physiology and Chronic Health Evaluation III score, other blood component transfusions, number of RBC transfusions, pretransfusion hemoglobin concentration, and cardiac surgery, the odds ratio for hospital mortality for patients exposed to the older three quartiles compared with the lowest quartile was 2.01 (95% confidence interval = 1.07 to 3.77).
CONCLUSIONS:
In critically ill patients, in Australia and New Zealand, exposure to older RBCs is independently associated with an increased risk of death.
- PMID:
- 21496231
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC3219399
Free PMC ArticleFigure 2
Predicted risk of death against maximum age of red blood cells. A locally weighted nonparametric smoother (LOWESS) for the predicted probability of death and the maximum age of red blood cells.
Crit Care. 2011;15(2):R116-R116.
Figure 1
Hospital mortality according to maximum age of red blood cells. Hospital mortality (%, 95% confidence interval) according to the maximum age of red blood cells (RBCs) (days). Patients with the maximum age of RBCs exceeding each cut-off point are excluded.
Crit Care. 2011;15(2):R116-R116.
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