Characterizing red blood cell age exposure in massive transfusion therapy: the scalar age of blood index (SBI)
BACKGROUND The mortality of trauma patients requiring massive transfusion to treat hemorrhagic shock approaches 17% at 24 hours and 26% at 30 days. The use of stored RBCs is limited to less than 42 days, so older RBCs are delivered first to rapidly bleeding trauma patients. Patients who receive a gr...
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Published in | Transfusion (Philadelphia, Pa.) Vol. 59; no. 8; pp. 2699 - 2708 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.08.2019
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | BACKGROUND
The mortality of trauma patients requiring massive transfusion to treat hemorrhagic shock approaches 17% at 24 hours and 26% at 30 days. The use of stored RBCs is limited to less than 42 days, so older RBCs are delivered first to rapidly bleeding trauma patients. Patients who receive a greater quantity of older RBCs may have a higher risk for mortality.
METHODS AND MATERIALS
Characterizing blood age exposure requires accounting for the age of each RBC unit and the quantity of transfused units. To address this challenge, a novel Scalar Age of Blood Index (SBI) that represents the relative distribution of RBCs received is introduced and applied to a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized controlled trial (NCT01545232, https://clinicaltrials.gov/ct2/show/NCT01545232). The effect of the SBI is assessed on the primary PROPPR outcome, 24‐hour and 30‐day mortality.
RESULTS
The distributions of blood storage ages successfully maps to a parameter (SBI) that fully defines the blood age curve for each patient. SBI was a significant predictor of 24‐hour and 30‐day mortality in an adjusted model that had strong predictive ability (odds ratio, 1.15 [1.01‐1.29], p = 0.029, C‐statistic, 0.81; odds ratio, 1.14 [1.02‐1.28], p = 0.019, C‐statistic, 0.88, respectively).
CONCLUSION
SBI is a simple scalar metric of blood age that accounts for the relative distribution of RBCs among age categories. Transfusion of older RBCs is associated with 24‐hour and 30‐day mortality, after adjustment for total units and clinical covariates. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-News-3 content type line 23 Composition of manuscript: All authors Analysis of data: SD, DB, HW Critical review of data: All authors Indicates co-first author Design and conceptualization of the study: SD, HW Execution of study and collection of data: SD, DB, AJ, HW, JH Approval of overall manuscript: All authors Critical review of manuscript: All authors Author Contributions Overall responsibility for paper: SD |
ISSN: | 0041-1132 1537-2995 |
DOI: | 10.1111/trf.15334 |