Volume-dependent relationship of fresh compared to standard red blood cells in critically ill adults: a subgroup analysis of the age of blood evaluation trial
Notice bibliographique
Résumé
BACKGROUND: Red blood cells (RBCs) preserved for transfusion accumulate multiple changes over time, collectively termed the storage lesion. Stored RBCs have been associated with deleterious clinical outcomes, including increased risk of death, in non-randomized studies, however recent randomized trials have not shown a clinical benefit with fresh compared to standard RBCs. It is unclear if the effect of the storage lesion is associated with the volume of RBCs transfused. OBJECTIVE: To determine if the effect of fresh compared to standard RBC units on mortality in critically ill adults is volume-dependent. METHODS: Sub-group analysis of the Age of Blood Evaluation (ABLE) trial, a multi-center study that randomized adult patients admitted to the Intensive Care Unit (ICU) to receive fresh (stored ≤7 days) or standard-issue RBCs (distributed according to a first-in, first-out policy), was performed. In a pre-planned analysis, the hazard of death and adjusted survival at 90 days was compared between treatment arms for subjects receiving up to 3 RBCs, and subjects receiving more than 3 RBCs using Cox proportional hazards regression. Hazard ratios (HR) were adjusted for age, sex, number of RBCs transfused, APACHE II score and MODS at randomization, comorbid conditions, reason for admission to ICU, ICU type (trauma, medical, or surgical), type of admission (emergency or elective), co-transfusions, and duration of supportive care. Similar analyses were done for secondary endpoints of mortality at 28 days, 180 days, in-ICU, and in-hospital. The dose response was further explored using subgroups defined by smaller transfusion increments. RESULTS: Complete follow-up was available for 2430 patients (≤3 RBCs: 789 standard arm vs. 754 fresh arm; >3 RBCs: 430 standard arm vs. 457 fresh arm). The HR for 90-day mortality was 1.08 (95% CI 0.94-1.25) overall, 1.20 (95% CI 0.99-1.42) for patients transfused ≤3 RBCs, and 0.90 (95% CI 0.69-1.10) for patients transfused >3 RBCs. Similar trends were seen for other mortality endpoints. There was evidence of statistical interaction between the storage age and number of RBC units transfused on mortality at 90 and 180 days. The exploratory analysis suggested a dose-effect of fresh compared to standard blood, with lower hazard of death at all time-points for patients receiving 6 or more fresh RBC units. CONCLUSIONS: In the pre-planned subgroup analysis, there was a non-significant trend favouring standard RBCs in patients transfused ≤3 RBC units, while fresh RBCs were favoured in patients transfused >3 RBC units. More detailed analyses demonstrated a trend of increased hazard of death with fresh compared to standard RBC units for patients transfused up to 3 RBC units, and decreased hazard of death with fresh compared to standard RBCs for patients transfused more than 5 RBC units. Interaction between storage age and number of transfusions was statistically significant for mortality at 90 and 180 days. These findings suggest a volume-dependent effect of fresh RBCs on mortality in critically ill adults, although the findings should be interpreted cautiously as this subgroup analysis was primarily exploratory. The findings should be confirmed in other randomized trials.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,006 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».