Abstract
Packed red blood cells (PRBCs), stored for prolonged intervals, might contribute to adverse clinical outcomes in critically ill patients. In this study, short-term outcome after transfusion of PRBCs of two storage duration periods was analyzed in patients with Acute Respiratory Distress Syndrome (ARDS). Patients who received transfusions of PRBCs were identified from a cohort of 1044 ARDS patients. Patients were grouped according to the mean storage age of all transfused units. Patients transfused with PRBCs of a mean storage age ≤ 28 days were compared to patients transfused with PRBCs of a mean storage age > 28 days. The primary endpoint was 28-day mortality. Secondary endpoints included failure-free days composites. Two hundred and eighty-three patients were eligible for analysis. Patients in the short-term storage group had similar baseline characteristics and received a similar amount of PRBC units compared with patients in the long-term storage group (five units (IQR, 3–10) vs. four units (2–8), p = 0.14). The mean storage age in the short-term storage group was 20 (±5.4) days compared with 32 (±3.1) days in the long-term storage group (mean difference 12 days (95%-CI, 11–13)). There was no difference in 28-day mortality between the short-term storage group compared with the long-term storage group (hazard ratio, 1.36 (95%-CI, 0.84–2.21), p = 0.21). While there were no differences in ventilator-free, sedation-free, and vasopressor-free days composites, patients in the long-term storage group compared with patients in the short-term storage group had a 75% lower chance for successful weaning from renal replacement therapy (RRT) within 28 days after ARDS onset (subdistribution hazard ratio, 0.24 (95%-CI, 0.1–0.55), p < 0.001). Further analysis indicated that even a single PRBC unit stored for more than 28 days decreased the chance for successful weaning from RRT. Prolonged storage of PRBCs was not associated with a higher mortality in adults with ARDS. However, transfusion of long-term stored PRBCs was associated with prolonged dependence of RRT in critically ill patients with an ARDS.
Highlights
Transfusion of packed red blood cells (PRBCs) is a frequent and often lifesaving therapy in critically ill patients
Further analysis indicated that even a single Packed red blood cells (PRBCs) unit stored for more than 28 days decreased the chance for successful weaning from renal replacement therapy (RRT)
With regard to the primary endpoint, the findings of this study are in concordance with data of previous large randomized controlled trials (RCTs) that suggested that the storage age of PRBCs does not impact mortality in Adult Intensive Care Unit (ICU) patients [14,15,16,17]
Summary
Transfusion of packed red blood cells (PRBCs) is a frequent and often lifesaving therapy in critically ill patients. In the US, leukoreduced PRBCs can be stored for up to 42 days [1]. Erythrocytes undergo complex morphologic and biochemical changes. Altered red cell membrane configuration and plasticity decrease erythrocyte stability, rendering RBCs prone to hemolysis with consecutive liberation of potassium, lactate dehydrogenase, microparticles, hemoglobin, and subsequently heme and iron into the storage solution or the vasculature of the transfusion recipient [2,3]. Besides disturbances of serum electrolytes, the released content of the RBCs causes vascular nitric oxide depletion, vasoconstriction, platelet aggregation, inflammation, mitochondrial damage, and production of reactive oxygen species [3,4,5,6,7]. Bioactive lipids, cytokines, and chemokines are generated within the PRBC units during storage and can trigger immune reactions as well as systemic organ injury upon transfusion [8,9]
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