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Gittess D, Anderson RD. Editorial response to "Outcomes in transcatheter aortic valve replacement (TAVR) patients requiring red blood cell transfusion: A nationwide perspective". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00636-5. [PMID: 39191614 DOI: 10.1016/j.carrev.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024]
Affiliation(s)
- David Gittess
- University of Florida, Department of Internal Medicine, United States of America
| | - R David Anderson
- University of Florida, Division of Cardiovascular Medicine, United States of America.
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Lv Y, Xiang Q, Lin J, Jin YZ, Fang Y, Cai HM, Wei QD, Wang H, Wang C, Chen J, Ye J, Xie C, Li TL, Wu YJ. There is no dose-response relationship between allogeneic blood transfusion and healthcare-associated infection: a retrospective cohort study. Antimicrob Resist Infect Control 2021; 10:62. [PMID: 33781329 PMCID: PMC8008558 DOI: 10.1186/s13756-021-00928-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/11/2021] [Indexed: 01/28/2023] Open
Abstract
Background The association between allogeneic blood transfusion and healthcare-associated infection (HAI) is considered dose-dependent. However, this association may be confounded by transfusion duration, as prolonged hospitalization stay increases the risk of HAI. Also, it is not clear whether specific blood products have different dose–response risks. Methods In this retrospective cohort study, a logistic regression was used to identify confounding factors, and the association between specific blood products and HAI were analyzed. Then Cox regression and restricted cubic spline regression was used to visualize the hazard of HAI per transfusion product. Results Of 215,338 inpatients observed, 4.16% were transfused with a single component blood product. With regard to these transfused patients, 480 patients (5.36%) developed a HAI during their hospitalization stay. Logistic regression showed that red blood cells (RBCs) transfusion, platelets transfusion and fresh-frozen plasmas (FFPs) transfusion were risk factors for HAI [odds ratio (OR) 1.893, 95% confidence interval (CI) 1.656–2.163; OR 8.903, 95% CI 6.646–11.926 and OR 1.494, 95% CI 1.146–1.949, respectively]. However, restricted cubic spline regression analysis showed that there was no statistically dose–response relationship between different transfusion products and the onset of HAI. Conclusions RBCs transfusion, platelets transfusion and FFPs transfusion were associated with HAI, but there was no dose–response relationship between them.
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Affiliation(s)
- Yu Lv
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China.
| | - Qian Xiang
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Jia Lin
- Blood Transfusion Department, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Ying Z Jin
- Healthcare-Associated Infections Control Center, Hospital (T.C.M) Affiliated to Southwest Medical University, LuZhou, Sichuan, People's Republic of China
| | - Ying Fang
- Department of Nursing, Jianyang People's Hospital, Jianyang, 641400, Sichuan, People's Republic of China
| | - Hong M Cai
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Qiong D Wei
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Hui Wang
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Chen Wang
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China.
| | - Jing Chen
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Jian Ye
- Nosocomial Infection Management Department, Affiliated Hospital of Sichuan Nursing Vocational College, Chengdu, 610000, Sichuan, People's Republic of China
| | - Caixia Xie
- Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Ting L Li
- Development Department, Chengdu Yiou Technology Co. LTD, Chengdu, 610000, Sichuan, People's Republic of China
| | - Yu J Wu
- Healthcare-Associated Infection Management Office, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China.
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Bonde A, Kirial R, Svenningsen P, Sillesen M. The effect of fluid resuscitation strategy on monocyte and T-cell surface markers. J Surg Res 2018; 230:20-27. [PMID: 30100035 DOI: 10.1016/j.jss.2018.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/26/2018] [Accepted: 04/13/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite initial lifesaving benefits, posttraumatic resuscitation strategies have been associated with immunologic complications leading to systemic inflammatory response syndrome, sepsis, multiple organ failure, and late trauma death. Nevertheless, the direct effect on immunologic surface markers remains inadequately described. We hypothesized that changes in monocyte and T-cell surface markers were associated with initial posttraumatic fluid resuscitation. MATERIALS AND METHODS Data were extracted from the inflammation and host response to injury (Glue Grant) study. Blood samples were drawn from 492 patients on days 0, 1, 4, 7, 14, and 28 and analyzed for 31 monocyte and T-cell surface markers. Resuscitation strategies during the initial 48 h were quantified, including transfusion of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and crystalloids. Longitudinal surface marker concentration changes were quantified by the calculation of a within-patient signal intensity change and were associated with resuscitation strategy while controlling confounders. P-values were post hoc corrected using the false detection rate q-value. RESULTS The monocyte surface marker (CD83) trajectory (as measured by a within-patient signal intensity change) was found to be positively associated with volume of PRBCs transfused (q = 0.002) and negatively associated with the transfused volume of FFP (q = 0.004). T-cell surface marker (CD3) was found to be negatively associated with volume of PRBCs transfused (q = 854 × 10-9) and positively associated with the transfused volume of FFP (q = 0.022). Platelets and crystalloid transfusion volumes were not associated with any surface marker trajectories. CONCLUSIONS PRBC and FFP transfusion was associated with opposing effects on CD3 and CD83 trajectories, which may in part explain some of the protective effects of a high FFP:PRBC ratio in trauma-related resuscitation.
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Affiliation(s)
- Alexander Bonde
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Kirial
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Svenningsen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Institute for Inflammation Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Bonde A, Nordestgaard AT, Kirial R, Svenningsen P, Sillesen M. The effect of resuscitation strategy on the longitudinal immuno-inflammatory response to blunt trauma. Injury 2017; 48:2670-2674. [PMID: 28988067 DOI: 10.1016/j.injury.2017.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/27/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Resuscitation strategies following blunt trauma have been linked to immuno-inflammatory complications leading to systemic inflammatory syndrome (SIRS), sepsis and multiple organ failure (MOF). The effect of resuscitation strategy on longitudinal inflammation marker trajectories is, however, unknown. We hypothesized that the effect of resuscitation strategy extends beyond the trauma-related coagulopathy, perhaps affecting the longitudinal immuno-inflammatory response to injury. METHODS We analyzed data prospectively collected for the Inflammation and Host Response to Injury (Glue Grant) study. Blood sampling for inflammation marker analyses from blunt trauma patients was done on admission days 0, 1, 4, 7, 14, 21 and 28 where applicable. Total volume transfused of packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets (PLT), and crystalloids during the initial 48h was extracted, along with an analysis for an array of cytokines by Enzyme Linked Immunosorbent Assay (ELISA) technique. A within patient concentration change (WPCC) was calculated to quantify longitudinal alterations in cytokine levels, while controlling for potential confounders. To account for the multiple comparisons performed, p-values obtained from the multivariate regression model were post-hoc corrected by the false detection rate (FDR) q-value. RESULTS No longitudinal trajectories of inflammatory markers were found to be associated with PRBC- or PLT transfusion. Three proinflammatory cytokines (Il-1β, MIP-1β, and TNFR2) were negatively associated with volume of FFP transfused (q=0.02, q<0.001 and q=0.007 respectively), and one proinflammatory cytokine (MIP-1β) was positively associated with crystalloid infusion (q=0.005). CONCLUSIONS Resuscitation strategy employed following blunt trauma has limited association to longitudinal inflammation marker trajectories, with a potential association between the strategy employed and IL-1β, TNFR2, and MIP-1β trajectories, respectively.
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Affiliation(s)
- Alexander Bonde
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ask Tybjærg Nordestgaard
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA; Department of Anaesthesia, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Rasmus Kirial
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Peter Svenningsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Denmark; Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Injury severity, sex, and transfusion volume, but not transfusion ratio, predict inflammatory complications after traumatic injury. Heart Lung 2017; 46:114-119. [DOI: 10.1016/j.hrtlng.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/25/2016] [Accepted: 12/11/2016] [Indexed: 01/28/2023]
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The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome. Am J Surg 2013; 205:457-65. [DOI: 10.1016/j.amjsurg.2012.07.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/06/2012] [Accepted: 07/17/2012] [Indexed: 12/17/2022]
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Kidney transplantation with and without simultaneous bilateral native nephrectomy in patients with polycystic kidney disease: a comparative retrospective study. Transplantation 2012; 94:383-8. [PMID: 22828736 DOI: 10.1097/tp.0b013e31825812b9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with autosomal dominant polycystic kidney disease (ADPKD) often need to undergo native nephrectomy and are candidates for kidney transplantation. The necessity and timing of nephrectomy are controversial. Some authors recommend simultaneous bilateral native nephrectomy (SBN) as the preferred option in living-donor kidney transplantation (LDKT). These recommendations are based on small study populations. We therefore set out to study outcomes of LDKT with SBN, compared with LDKT alone in a larger single-center cohort. METHODS A consecutive series of 159 patients with ADPKD undergoing LDKT were included in the study. Of the 159 patients, 2 were excluded because of missing data, 79 underwent LDKT alone (group A), and 78 underwent LDKT with SBN (group B). Demographic data and intraoperative and postoperative data were collected from patient charts and the national kidney registry. RESULTS There were no differences regarding background data. Group B experienced significantly longer operating times (183.7 vs. 319.3 min, P<0.001), a greater need for blood transfusions (0.1 vs. 1.6 units, P<0.001) and plasma products (35.1 vs. 438.3 mL, P<0.001), and longer hospital stays (11.8 vs. 15.4 days, P<0.001). It also experienced more intraoperative events and postoperative complications but fewer reoperations/reinterventions. There were no differences in patient and graft survival rates. CONCLUSIONS SBN in patients undergoing LDKT for ADPKD does not have a significant negative impact on patient and graft survival rates. It obviates a separate surgical procedure but requires longer hospital stay. It may be associated with more postoperative complications and risk of graft loss. These considerations should be communicated to the recipient and the donor.
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Pieracci FM, Witt J, Moore EE, Burlew CC, Johnson J, Biffl WL, Barnett CC, Bensard DD. Early death and late morbidity after blood transfusion of injured children: a pilot study. J Pediatr Surg 2012; 47:1587-91. [PMID: 22901922 DOI: 10.1016/j.jpedsurg.2012.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/07/2012] [Accepted: 02/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Early postinjury death after packed red blood cell (pRBC) transfusion is attributed to uncontrolled hemorrhage and coagulopathy. The adverse immunomodulatory effects of blood transfusion are implicated in subsequent morbidity. We hypothesized that injured children requiring pRBC transfusion demonstrate patterns in outcome similar to those observed in adults. METHODS Our prospectively collected trauma registry was queried for demographics, treatment, and outcome (2006-2009). Outcomes of children who received pRBC transfusion were compared with those of age- and Injury Severity Score (ISS)-matched children who did not receive pRBC transfusion by both univariate and multivariable analysis. RESULTS Eight percent (43/512) of injured children received a pRBC transfusion: 20 early and 23 late. The likelihood of pRBC transfusion increased with increasing ISS (ISS <15, 2%; ISS 16-25, 17%; ISS >25, 72%). One-half of injured children who received an early pRBC transfusion died; however, most deaths were because of central nervous system injury. Both ventilator and intensive care unit days were increased in children who received pRBC transfusion as compared with those who did not. CONCLUSION Early pRBC transfusion is associated with a high mortality in children. Late blood transfusion is associated with worse outcomes, although this relationship may not be causal. This pilot study provides evidence of an association between pRBC transfusion, morbidity, and mortality among injured children that warrants refinement in larger, prospective investigations.
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Affiliation(s)
- Fredric M Pieracci
- Department of Surgery, Denver Health Medical Center, Denver, CO 80206, USA.
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Predicting acute kidney injury among burn patients in the 21st century: a classification and regression tree analysis. J Burn Care Res 2012; 33:242-51. [PMID: 22370901 DOI: 10.1097/bcr.0b013e318239cc24] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Historically, acute kidney injury (AKI) carried a deadly prognosis in the burn population. The aim of this study is to provide a modern description of AKI in the burn population and to develop a prediction tool for identifying patients at risk for late AKI. A large multi-institutional database, the Glue Grant's Trauma-Related Database, was used to characterize AKI in a cohort of critically ill burn patients. The authors defined AKI according to the RIFLE criteria and categorized AKI as early, late, or progressive. They then used Classification and Regression Tree (CART) analysis to create a decision tree with data obtained from the first 48 hours of admission to predict which subset of patients would develop late AKI. The accuracy of this decision tree was tested in a separate, single-institution cohort of burn patients who met the same criteria for entry into the Glue Grant study. Of the 220 total patients analyzed from the Glue Grant cohort, 49 (22.2%) developed early AKI, 39 (17.7%) developed late AKI, and 16 (7.2%) developed progressive AKI. The group with progressive AKI was statistically older, with more comorbidities and with the worst survival when compared with those with early or late AKI. Using CART analysis, a decision tree was developed with an overall accuracy of 80% for the development of late AKI for the Glue Grant dataset. The authors then tested this decision tree on a smaller dataset from our own institution to validate this tool and found it to be 73% accurate. AKI is common in severe burns with notable differences between early, late, and progressive AKI. In addition, CART analysis provided a predictive model for early identification of patients at highest risk for developing late AKI with proven clinical accuracy.
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Fresh frozen plasma/red blood cell resuscitation regimen that restores procoagulants without causing adult respiratory distress syndrome. J Trauma Acute Care Surg 2012; 72:821-7. [PMID: 22491592 DOI: 10.1097/ta.0b013e3182484111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Controversy exists about the ideal fresh frozen plasma/red blood cell (FFP/RBC) ratio for resuscitation of patients requiring massive transfusion (MT). This study correlates the FFP/RBC with clotting time (CT), prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time (TT); with procoagulants (fibrinogen [FI], factor 5 [FV], and factor 8 [FVIII]); and with adult respiratory distress syndrome (pO2/FIO2). METHODS The 32 patients studied in operating room (OR) were in shock for 47 minutes and received an average of 17.6 units RBC, 4.2 units FFP, and 14.2 L balanced electrolyte solution. The 53 patients (including 22 of the OR patients), studied an average of 9.5 hours after operation, had an average shock time of 42 minutes, and received 17.4 units RBC, 4.6 units FFP, and 12.3 L balanced electrolyte solution in OR. RESULTS The FFP/RBC in OR averaged 0.3:1 (range: 0.1:1 to 0.9:1). The OR study, done after a minimum of 10 RBC units at 3.8 hours, showed a PT of 3.5 seconds off normal (international normalized ratio < 1.3), a PTT of 34 seconds, and TT of 7.9 seconds off normal. FI, FV, and FVIII were restored to 148 mg/dL, 54%, and 81%. The pO2/FIO2 was 282. The early post-OR study showed a PT of 2.3 seconds off normal (international normalized ratio = 1.2), a PTT of 32 seconds, a TT of 7.2 seconds off normal, an FI of 207 mg/dL, an FV of 64%, an FVIII of 102%, and a pO2/FIO2 of 332. Both OR and early post-OR CTs and procoagulant levels are associated with adequate coagulation. All patients with a 0.31:1 or higher FFP/RBC had sufficient restoration of CTs and procoagulants. CONCLUSION These data show that an FFP/RBC ratio above 0.31:1 in injured patients requiring MT restores CTs and procoagulant to clinically effective levels while not causing adult respiratory distress syndrome. Future studies on defining the ideal FFP/RBC ratio for MT should monitor CTs, procoagulants, and organ function.
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