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) |