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Table 2 Studies reporting a clinically harmful effect of prolonged RBC storage

From: Age of red blood cells and transfusion in critically ill patients

Authors Year Setting N Study design Main confounders used for adjustment Leukodepletion Outcome and main results
Purdy et al.[16] 1997 ICU, severe sepsis or septic shock 31 Retrospective single-center No No Median of RBC storage was lower in survivors (17 days) than in nonsurvivors (median 25 days) (p < 0.0001)
Zallen et al.[28] 1999 Trauma, ≥6 RBCs units in the first 12 hours post injury 63 Retrospective single-center Patient age, serum lactate, base deficit No Mean age of RBC >14 days associated with MOF (OR 1.16, CI 95%, 1.01-1.34, p = 0.03)
Vamvakas et al.[23] 1999 Post-CABG 416 Retrospective single-center Chronic systemic illness, CABG surgery type, IABP, intubation, impaired consciousness, patient age, bypass time, chest tube drainage, admission WBC count No Oldest blood was associated with a higher risk of pneumonia and/or wound infection compared with fresh blood (median of the mean age of the oldest and second oldest RBC units = 21.6 (range: 4–41) days vs. 13 (range: 2–39) days, p = 0.0002)
Offner et al.[26] 2002 Trauma, ≥ 6 RBC units in the first 12 hours postinjury 61 Prospective single-center observational Patient age, ISS, gender, mechanism of injury No Risk of major infectious complications increased with the number of RBC units >14 days (OR = 1.13, 95% CI, 1.01-1.26, p = 0.03)
Keller et al.[29] 2002 Trauma with up to 4 RBC units in the first 48 hours post injury 86 Retrospective single-center ISS, requirement for surgery, volume of RBC, patient age No Association between the number of RBC >14 days and hospital LOS
Leal-Noval et al.[24] 2003 Post-CABG or valve surgery 585 Prospective single-center observational Re-intubation, central nervous system dysfunction, Apache II score, MV duration No Association between older RBC (>28 days) and the risk of pneumonia (OR = 1.06, 95% CI, 1.01-1.11, p = 0.018) No association with mortality
Murrell et al.[30] 2005 Trauma 275 Retrospective single-center Patient age, ISS, leukodepletion volume of RBC 95% Association between older blood and longer ICU and hospital LOS (RR = 1.15, 95% CI, 1.11-1.2) No association with mortality
Koch et al.[18] 2008 Post-CABG or valve surgery 6002 Retrospective single-center Baseline characteristics Mixed Old blood >14 days was associated with mortality, MV duration, renal failure, infections and MOF
Weinberg et al.[17] 2008 Trauma, ≥ 1 RBC unit in the first 24 hours post injury 1813 Retrospective single-center Patient age, gender, ISS, mechanism of injury, volume of RBC, hospital LOS Yes Transfusion ≥6 RBC units of RBC older ≥14 days was associated with higher mortality
Weinberg et al.[22] 2008 Trauma without RBC transfusion in the first 48 hours post injury 430 Retrospective single-center Patient age, gender, ISS, presence of thoracic injury, MV, volume of RBC Yes RBC ≥14 days was associated with mortality (OR = 1.12, 95% CI: 1.02 to 1.23), renal failure (OR = 1.18, 95% CI, 1.07-1.29) and pneumonia (OR = 1.10, 95% CI, 1.04-1.17) Not with ARDS
Weinberg et al.[41] 2010 Trauma, ≥1 RBC unit for the first 24 hours 1647 Retrospective single-center Patient age, gender, ISS, mechanism of injury, volume of RBC,FFP and platelets, presence of head injury Yes 3 or more RBC ≥14 days increased risk of death (RR = 1.57, 95% CI, 1.14-2.15, p = 0.01)
Spinella et al.[20] 2009 Trauma, ≥5 RBC units 202 Retrospective single-center Patient age, cryoprecipitate, Glasgow coma score, ISS Mixed Association between RBC >21 days and DVT occurrence Association between RBC >28 days and mortality (OR = 4, 95% CI, 1.34-11.61)
Vandrome et al.[27] 2009 Trauma 487 Retrospective single-center Patient age, gender, ISS, mechanism of injury and MV time Yes Risk of pneumonia higher in patients transfused with RBC ≥14 days (RR = 1.42, 95% CI, 1.01-2.02)
Robinson et al.[21] 2010 Post-percutaneous coronary intervention 909 Retrospective multi center Volume of RBC, procedures details, demographic characteristics NG Increased in age of the youngest RBC was associated with 30-day mortality (HR = 1.02, 95% CI, 1.18-1.34, p < 0.001)
Eikelboom et al.[19] 2010 Acute cardiovascular disease 4933 Prospective single-center observational Demographic characteristics, comorbidities, clinical characteristics, patient ABO group Yes Hospital mortality higher when the oldest RBC >31 days compared with RBC <10 days (RR = 1.48, 95% CI, 1.07-2.05)
Andreasen et al.[25] 2011 Post-CABG or valve surgery 1748 Retrospective multicenter Place of surgery, patient age gender, BMI, preoperative Hb, diabetes, reoperation due to bleeding, use of cardiopulmonary bypass, concomitant valve surgery, comorbidities, volume of RBC and platelets units, ABO blood group Mixed Higher risk of severe postoperative infections (OR = 2.5, 95% CI, 1.2-4.2) in patients with RBC exclusively ≥14 days
Pettila et al.[15] 2011 ICU 757 Prospective multicenter observational Apache III score, leukodepletion status, pre-ICU transfusion, cardiac surgery, other transfused blood components, pretransfusion Hb preceding the first transfusion, centers 80% Oldest RBC associated with longer LOS and higher mortality
Juffermans et al.[61] 2012 Trauma 196 Retrospective single-center ISS, head trauma, surgery, use for SDD, volume of RBC and of platelets Yes Patients with infections received more old blood (>14 days) than patients without infections (8 RBC units (range: 2–16) versus 4 RBC units (range: 2–8), p = 0.02)
  1. RBC red blood cells; ICU intensive care unit; LOS length of stay; MV mechanical ventilation; DVT deep vein thrombosis; ARDS acute respiratory distress syndrome; CABG coronary artery bypass graft; MOF multi organ failure; IABP intra-aortic balloon pump; WBC White blood cells; ISS injury severity score; APACHE II score Acute Physiology and Chronic Health Evaluation II score; RR relative risk; BMI body mass index; Hb hemoglobin; FFP fresh frozen plasma; SDD selective digestive decontamination, NG not given.