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. 2010;14(2):R57.
doi: 10.1186/cc8953. Epub 2010 Apr 8.

Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study

Oliver Karam  1 , Marisa Tucci, Scot T Bateman, Thierry Ducruet, Philip C Spinella, Adrienne G Randolph, Jacques Lacroix
Affiliations

Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study

Oliver Karam et al. Crit Care. 2010.

Abstract

Introduction: Transfusion is a common treatment in pediatric intensive care units (PICUs). Studies in adults suggest that prolonged storage of red blood cell units is associated with worse clinical outcome. No prospective study has been conducted in children. Our objectives were to assess the clinical impact of the length of storage of red blood cell units on clinical outcome of critically ill children.

Methods: Prospective, observational study conducted in 30 North American centers, in consecutive patients aged <18 years with a stay >or= 48 hours in a PICU. The primary outcome measure was the incidence of multiple organ dysfunction syndrome after transfusion. The secondary outcomes were 28-day mortality and PICU length of stay. Odds ratios were adjusted for gender, age, number of organ dysfunctions at admission, total number of transfusions, and total dose of transfusion, using a multiple logistic regression model.

Results: The median length of storage was 14 days in 296 patients with documented length of storage. For patients receiving blood stored >or= 14 days, the adjusted odds ratio for an increased incidence of multiple organ dysfunction syndrome was 1.87 (95% CI 1.04;3.27, P = 0.03). There was also a significant difference in the total PICU length of stay (adjusted median difference +3.7 days, P < 0.001) and no significant change in mortality.

Conclusions: In critically ill children, transfusion of red blood cell units stored for >or= 14 days is independently associated with an increased occurrence of multiple organ dysfunction syndrome and prolonged PICU stay.

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Figures

Figure 1
Figure 1
Distribution of RBC length of storage. The horizontal axis represents the red blood cell (RBC) length of storage (in days). The vertical axis represents the number of patients who received transfusions for each known length of storage. The black part of each bar of the histogram represents the number of patients who developed new or progressive multiple organ dysfunction score (MODS). For patients receiving multiple transfusions, the longest length of storage was used. The median length of storage is 14 days, and the mean length of storage is 17.2 days.
Figure 2
Figure 2
Box plot of the maximum RBC length of storage, according to the number of RBC transfusions and according to the severity of disease at admission (PRISM III score ≤ 10 versus >10). RBC, red blood cell; PRISM, pediatric risk of mortality; NS, not significant.
Figure 3
Figure 3
Adjusted PICU length of stay, according to RBC unit length of storage. The Cox regression model is adjusted for gender, age, multiple organ dysfunction score (MODS) at admission, mechanical ventilation at admission, total number of transfusions, and total transfusion dose. Adjusted median difference in pediatric intensive care unit (PICU) length of stay was 3.7 days (P < 0.001); hazard ratio = 1.39 (95% CI = 1.07 to 1.80, P = 0.01).
Figure 4
Figure 4
Time to develop new or progressive MODS. Adjusted proportion of patients free of primary outcome (new or progressive multiple organ dysfunction score (MODS)), according to the red blood cell (RBC) length of storage (<14 days versus ≥ 14 days). The Cox regression model was adjusted for gender, age, MODS at admission, mechanical ventilation at admission, total number of transfusions, and total transfusion volume. Hazard ratio = 1.43 (95% CI = 0.96 to 2.15, P = 0.08).
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