Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock 英文参考文献.docVIP

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Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock 英文参考文献.doc

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Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock 英文参考文献

Parsonsetal.CriticalCare2011,15:R221 /content/15/5/R221 RESEARCH OpenAccess Redbloodcelltransfusionandoutcomesin patientswithacutelunginjury,sepsisandshock ElizabethCParsons1*,CatherineLHough1,ChristopherWSeymour2,ColinRCooke3,GordonDRubenfeld4and TimothyRWatkins1,5,fortheNHLBIARDSNetwork Abstract Introduction:Inthisstudy,wesoughttodeterminetheassociationbetweenredbloodcell(RBC)transfusionand outcomesinpatientswithacutelunginjury(ALI),sepsisandshock. Methods:Weperformedasecondaryanalysisofnew-onsetALIpatientsenrolledintheAcuteRespiratoryDistress SyndromeNetworkFluidandCatheterTreatmentTrial(2000to2005)whohadadocumentedALIriskfactorof sepsisorpneumoniaandmetshockcriteria(meanarterialpressure(MAP)60mmHgorvasopressoruse)within 24hoursofrandomization.Usingmultivariablelogisticregression,weexaminedtheassociationbetweenRBC transfusionand28-daymortalityafteradjustmentforage,sex,race,randomizationarmandAcutePhysiologyand ChronicHealthEvaluationIIIscore.Secondaryendpointsincluded90-daymortalityandventilator-freedays(VFDs). Finally,weexaminedtheseendpointsamongthesubsetofsubjectsmeetingprespecifiedtransfusioncriteria definedbyfivesimultaneousindicators:hemoglobin10.2g/dL,centralormixedvenousoxygensaturation 70%,centralvenouspressure≥8mmHg,MAP≥65mmHg,andvasopressoruse. Results:Weidentified285subjectswithALI,sepsis,shockandtransfusiondata.Ofthese,85alsomettheabove prespecifiedtransfusioncriteria.Fifty-three(19%)ofthetwohundredeighty-fivesubjectswithshockandtwenty (24%)ofthesubsetmeetingthetransfusioncriteriareceivedRBCtransfusionwithintwenty-fourhoursof randomization.WefoundnoindependentassociationbetweenRBCtransfusionand28-daymortality(oddsratio= 1.49,95%CI(95%confidenceinterval)=0.77to2.90;P=0.23)orVFDs(meandifference=-0.35,95%CI=-4.03to 3.32;P=0.85).Likewise,90-daymortalityandVFDsdidnotdifferbytransfusionstatus.Amongthesubsetof patientsmeetingthetransfusioncriteria,wefoundnoindependentassociationbetweentransfusionandmortality orVFDs. Conclusions:Inpatientswithnew-onsetALI,