Scientific Papers
Age of transfused blood is an independent risk factor for postinjury multiple organ failure

Presented at the 51st Annual Meeting of the Southwestern Surgical Congress, Coronado, California, April 18–21, 1999.
https://doi.org/10.1016/S0002-9610(99)00239-1Get rights and content

Abstract

Background: Blood transfusion has repeatedly been demonstrated to be an independent risk factor for postinjury multiple organ failure (MOF). Previously believed to represent a surrogate for shock, packed red blood cell (PRBC) transfusion has recently been shown to result in neutrophil priming and pulmonary endothelial cell activation. We have previously observed that the generation of inflammatory mediators is related to the length of PRBC unit storage. The purpose of this study was to determine if age of transfused PRBC is a risk factor for the development of postinjury MOF.

Methods: Using our prospective database of trauma patients at risk for developing MOF, we identified patients who developed MOF (MOF+) and received 6 to 20 units of PRBCs in the first 12 hours following injury. A similar cohort of patients, matched for ISS and transfusion requirement, who did not develop MOF (MOF−) were also identified. The age of each unit of PRBC transfused in the first 6 hours was determined. Multiple logistic regression was performed to determine if age of transfused blood is an independent risk factor.

Results: Sixty-three patients were identified, 23 of whom were MOF+. There was no difference in ISS and transfusion requirement between MOF+ and MOF− groups. MOF+ patients, however, were significantly older (46 ± 4.7 years versus 33 ± 2.3 years). Moreover, mean age of transfused blood was greater in the MOF+ patients (30.5 ± 1.6 days versus 24 ± 0.5 days). Similarly, the mean number of units older than 14 and 21 days old were greater in the MOF+ patients. Multivariate analysis identified mean age of blood, number of units older than 14 days, and number of units older than 21 days as independent risk factors for MOF.

Conclusion: The age of transfused PRBCs transfused in the first 6 hours is an independent risk factor for postinjury MOF. This suggests that current blood bank processing and storage technique should be reexamined. Moreover, fresh blood may be more appropriate for the initial resuscitation of trauma patients requiring transfusion.

Section snippets

Materials and methods

The Colorado Multiple Institutional Review Board approved these studies, and all subjects gave informed consent prior to entry into the study. Patients were eligible for the study if they were aged >17 years, Injury Severity Score (ISS) >15 with at least one extracranial Abbreviated Injury Scale (AIS) >3, evidence of hemorrhagic shock (systolic blood pressure <90 mm Hg), less than 2 hours from their injury, and able to give consent.

Results

Sixty-three patients were identified, 23 of whom developed MOF (MOF+). The mechanism of injury was blunt in 38 patients and penetrating in 25 patients. There was no difference in ISS or transfusion requirement between MOF+ patients and patients who did not develop MOF (MOF−), but MOF+ patients were older (46 ± 4.7 years versus 33 ± 2.3 years, P = 0.03; Table I). Mean age of transfused blood was significantly greater in the MOF+ patients (Figure 1). Similarly, the mean number of units greater

Comments

Transfusion of blood has been identified to be a robust predictor of postinjury MOF.1, 3 Initially, this relationship was felt to reflect a correlation between tissue injury or hemorrhagic shock and blood transfusion requirement. Our subsequent work, however, has shown the number of blood transfusions to be an independent predictor of MOF.3 The recent discovery of the proinflammatory effects of stored blood have provided a possible mechanism for this process. The identification of inflammatory

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