La transfusión de concentrados de hematíes en pacientes críticos de una uci polivalente de argentina
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OBJETIVO: evaluar si la transfusión de concentrados de hematíes (CH) en el paciente crítico en nuestra Unidad de Cuidados Intensivos (UCI) se asocia a mayor mortalidad.
DISEÑO: Estudio retrospectivo y observacional realizado desde enero de 2009 a diciembre de 2018.
ÁMBITO: UCI polivalente.
PACIENTES: Mayores de 18 años, internados al menos durante 24 horas.
INTERVENCIONES: Ninguna.
VARIABLES DE INTERÉS: Número de transfusiones de CH y mortalidad en UCI.
RESULTADOS: Se analizaron 4244 pacientes que reunieron los datos requeridos. Edad promedio: 50,35 (±17,14) años, varones: 64,6%, días de internación: 6,61 (±8,94), APACHE II 14,74 (±8,67), SAPS II 36,87 (±19,40), SOFA 4,96 (±3,72), necesidad de VM: 46,9% y mortalidad 24,6%. Requirieron transfusiones de CH 735 (17,3%). Cuando se compararon éstos con los no transfundidos se pudo apreciar que los primeros presentaron menor edad (51 vs. 53 años, p<0,001), puntajes de gravedad más elevados (APACHE II 17 vs. 13 p<0,001; SAPS II 40 vs. 32 p<0,001; SOFA 6 vs. 4 p<0,001), mayor estancia en UCI (6 vs. 3 días, p<0,001), necesidad de VM (65,7 vs. 42,9%, p<0,001) y mortalidad (34vs. 22,6%, <0,001). El análisis de regresión logística multivariante mostró que los pacientes con mayor número de CH transfundidos presentaron mayor mortalidad en UCI [odds ratio de 1,066 (IC 95%: 1,015-1,119; p 0,01)], ajustando por edad, días de internación, escalas de gravedad y necesidad de VM.
CONCLUSIONES: A partir de estos resultados podemos concluir que la transfusión de CH en pacientes críticos se asoció con una mayor mortalidad en nuestra UCI.
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2. Hebert PC, Wells G, Tweeddale M, Martin C, Marshall J, Pham B, et al. Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group. American journal of respiratory and critical care medicine. 1997;155(5):1618-23.
3. Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM, et al. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation. 2006;113(23):2713-23.
4. Salisbury AC, Alexander KP, Reid KJ, Masoudi FA, Rathore SS, Wang TY, et al. Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction. Circulation Cardiovascular quality and outcomes. 2010;3(4):337-46.
5. Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348(9034):1055-60.
6. Park DW, Chun BC, Kwon SS, Yoon YK, Choi WS, Sohn JW, et al. Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis*. Critical care medicine. 2012;40(12):3140-5.
7. Sakr Y, Lobo S, Knuepfer S, Esser E, Bauer M, Settmacher U, et al. Anemia and blood transfusion in a surgical intensive care unit. Critical care. 2010;14(3):R92.
8. Napolitano LM, Kurek S, Luchette FA, Anderson GL, Bard MR, Bromberg W, et al. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. The Journal of trauma. 2009;67(6):1439-42.
9. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. Jama. 2002;288(12):1499-507.
10. Silva Junior JM, Rezende E, Amendola CP, Tomita R, Torres D, Ferrari MT, et al. Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy. Sao Paulo medical journal = Revista paulista de medicina. 2012;130(2):77-83.
11. Netzer G, Shah CV, Iwashyna TJ, Lanken PN, Finkel B, Fuchs B, et al. Association of RBC transfusion with mortality in patients with acute lung injury. Chest. 2007;132(4):1116-23.
12. Bochicchio GV, Napolitano L, Joshi M, Bochicchio K, Meyer W, Scalea TM. Outcome analysis of blood product transfusion in trauma patients: a prospective, risk-adjusted study. World journal of surgery. 2008;32(10):2185-9.
13. Croce MA, Tolley EA, Claridge JA, Fabian TC. Transfusions result in pulmonary morbidity and death after a moderate degree of injury. The Journal of trauma. 2005;59(1):19-23; discussion -4.
14. Bursi F, Barbieri A, Politi L, Di Girolamo A, Malagoli A, Grimaldi T, et al. Perioperative red blood cell transfusion and outcome in stable patients after elective major vascular surgery. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2009;37(3):311-8.
15. Robinson WP, 3rd, Ahn J, Stiffler A, Rutherford EJ, Hurd H, Zarzaur BL, et al. Blood transfusion is an independent predictor of increased mortality in nonoperatively managed blunt hepatic and splenic injuries. The Journal of trauma. 2005;58(3):437-44; discussion 44-5.
16. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. The New England journal of medicine. 1999;340(6):409-17.
17. Napolitano LM, Corwin HL. Efficacy of red blood cell transfusion in the critically ill. Critical care clinics. 2004;20(2):255-68.
18. Cabrales P, Martini J, Intaglietta M, Tsai AG. Blood viscosity maintains microvascular conditions during normovolemic anemia independent of blood oxygen-carrying capacity. American journal of physiology Heart and circulatory physiology. 2006;291(2):H581-90.
19. Tanaka S, Escudier E, Hamada S, Harrois A, Leblanc PE, Vicaut E, et al. Effect of RBC Transfusion on Sublingual Microcirculation in Hemorrhagic Shock Patients: A Pilot Study. Critical care medicine. 2017;45(2):e154-e60.
20. Zheng Y, Lu C, Wei S, Li Y, Long L, Yin P. Association of red blood cell transfusion and in-hospital mortality in patients admitted to the intensive care unit: a systematic review and meta-analysis. Critical care. 2014;18(6):515.
21. Engoren M, Arslanian-Engoren C. Long-term survival in the intensive care unit after erythrocyte blood transfusion. American journal of critical care : an official publication, American Association of Critical-Care Nurses. 2009;18(2):124-31; quiz 32.
22. Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P, Sepsis Occurrence in Acutely Ill Patients I. Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology. 2008;108(1):31-9.
23. Parsons EC, Hough CL, Seymour CW, Cooke CR, Rubenfeld GD, Watkins TR, et al. Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock. Critical care. 2011;15(5):R221.
24. Brophy DF, Harpe SE, Carl DE, Brophy GM. An Epidemiological Study of Anemia and Renal Dysfunction in Patients Admitted to ICUs across the United States. Anemia. 2012;2012:938140.
25. Sheth KN, Gilson AJ, Chang Y, Kumar MA, Rahman RM, Rost NS, et al. Packed red blood cell transfusion and decreased mortality in intracerebral hemorrhage. Neurosurgery. 2011;68(5):1286-92.
26. Sekhon MS, McLean N, Henderson WR, Chittock DR, Griesdale DE. Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury. Critical care. 2012;16(4):R128.