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Multicenter Study
. 2011;15(2):R116.
doi: 10.1186/cc10142. Epub 2011 Apr 15.

Age of red blood cells and mortality in the critically ill

Ville Pettilä  1 , Andrew J Westbrook, Alistair D Nichol, Michael J Bailey, Erica M Wood, Gillian Syres, Louise E Phillips, Alison Street, Craig French, Lynnette Murray, Neil Orford, John D Santamaria, Rinaldo Bellomo, David J Cooper; Blood Observational Study Investigators for ANZICS Clinical Trials Group
Collaborators, Affiliations
Multicenter Study

Age of red blood cells and mortality in the critically ill

Ville Pettilä et al. Crit Care. 2011.

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.

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Figures

Figure 1
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.
Figure 2
Figure 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.
See this image and copyright information in PMC

References

    1. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ. The CRIT Study: anemia and blood transfusion in the critically ill - current clinical practice in the United States. Crit Care Med. 2004;32:39–52. doi: 10.1097/01.CCM.0000104112.34142.79. - DOI - PubMed
    1. Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, Noveck H, Strom BL. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348:1055–1060. doi: 10.1016/S0140-6736(96)04330-9. - DOI - PubMed
    1. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001;345:1230–1236. doi: 10.1056/NEJMoa010615. - DOI - PubMed
    1. Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion. 2002;42:812–818. doi: 10.1046/j.1537-2995.2002.00123.x. - DOI - PubMed
    1. Lackritz EM, Campbell CC, Ruebush TK, Hightower AW, Wakube W, Steketee RW, Were JB. Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet. 1992;340:524–528. doi: 10.1016/0140-6736(92)91719-O. - DOI - PubMed

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