预防性输注血浆与减少重症患者红细胞需求无关
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Prophylactic Plasma Transfusion Is Not Associated With Decreased Red Blood Cell Requirements in Critically Ill Patients
背景与目的
重症患者常接受血浆输液，假设凝血检测结果异常将导致出血风险增加，血浆输液也会降低这种风险。然而，预防性血浆输液的效果仍然是很少了解。本研究的目的是探讨重症患者预防性血浆输液和出血并发症之间的关系。
方 法
这是2009-1-1至2013-12-31期间，在一个单一学术机构入住重症监护室（ICU）的，涉及成年人的回顾性队列研究。纳入标准包括年龄≥18岁，ICU入院期间采用国际标准化比例衡量。使用多变量倾向得分匹配分析来评估预防性血浆输液与目标结果之间的关系，主要结果是随后24小时内红细胞输注量，次要结果是医院和ICU住院天数以及出院后30天内的死亡率。
结 果
共有27,561例患者纳入调查，2472例（9.0％）患者接受血浆疗法，1105 例(44.7%)是预防性输液的患者。在多变量倾向得分匹配分析中，接受血浆的患者较高的红细胞输血率（优势比：4.3 [95％置信区间：3.3-5.7]，P <0.001），住院天数低（估计增加％ -11.0％[95％置信区间：-11.4，-10.6％]，P <0.001）。ICU住院日或死亡率组间无显着性差异。持续进行了多项预定义的敏感性分析，这些发现似乎很重要。
结 论
重症患者预防性给予血浆与临床疗效改善无关，有必要进一步探讨血浆输液在这类人群中的作用。
原始文献摘要
Matthew A. Warner, MD，Arun Chandran, MBBS,Gregory Jenkins, MS, and Daryl J. Kor, MD.Prophylactic Plasma Transfusion Is Not Associated With Decreased Red Blood Cell Requirements in Critically Ill Patients.Anesthesia & Analgesia. 124(5):1636-1643，2017.
BACKGROUND:Critically ill patients frequently receive plasma transfusion under the assumptions that abnormal coagulation test results confer increased risk of bleeding and that plasma transfusion will decrease this risk. However, the effect of prophylactic plasma transfusion remains poorly understood. The objective of this study was to determine the relationship between prophylactic plasma transfusion and bleeding complications in critically ill patients.
METHODS:This is a retrospective cohort study of adults admitted to the intensive care unit (ICU) at a single academic institution between January 1, 2009 and December 31, 2013. Inclusion criteria included age ≥18 years and an international normalized ratio measured during ICU admission. Multivariable propensity-matched analyses were used to evaluate associations between prophylactic plasma transfusion and outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of hospital- and ICU-free days and mortality within 30 days of ICU discharge.
RESULTS:A total of 27,561 patients were included in the investigation with 2472 (9.0%) receiving plasma therapy and 1105 (44.7%) for which plasma transfusion was prophylactic in nature. In multivariable propensity-matched analyses, patients receiving plasma had higher rates of red blood cell transfusion (odds ratio: 4.3 [95% confidence interval: 3.3–5.7], P < .001) and fewer hospital-free days (estimated % increase: −11.0% [95% confidence interval: −11.4, −10.6%], P < .001). There were no significant differences in ICU-free days or mortality. These findings appeared robust, persisting in multiple predefined sensitivity analyses.
CONCLUSIONS：Prophylactic administration of plasma in the critically ill was not associated with improved clinical outcomes. Further investigation examining the utility of plasma transfusion in this population is warranted.
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