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Characterizing red blood cell age exposure in massive transfusion therapy: the scalar age of blood index (SBI).

Authors
  • DeSantis, Stacia M1
  • Brown, Derek W1
  • Jones, Allison R2
  • Yamal, Jose-Miguel1
  • Pittet, Jean-Francois3
  • Patel, Rakesh P3
  • Wade, Charles E4
  • Holcomb, John B4
  • Wang, Henry5
  • 1 Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, Texas.
  • 2 Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
  • 3 Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama.
  • 4 Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas.
  • 5 Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
Type
Published Article
Journal
Transfusion
Publication Date
Aug 01, 2019
Volume
59
Issue
8
Pages
2699–2708
Identifiers
DOI: 10.1111/trf.15334
PMID: 31050809
Source
Medline
Language
English
License
Unknown

Abstract

The mortality of trauma patients requiring massive transfusion to treat hemorrhagic shock approaches 17% at 24 hours and 26% at 30 days. The use of stored RBCs is limited to less than 42 days, so older RBCs are delivered first to rapidly bleeding trauma patients. Patients who receive a greater quantity of older RBCs may have a higher risk for mortality. Characterizing blood age exposure requires accounting for the age of each RBC unit and the quantity of transfused units. To address this challenge, a novel Scalar Age of Blood Index (SBI) that represents the relative distribution of RBCs received is introduced and applied to a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized controlled trial (NCT01545232, https://clinicaltrials.gov/ct2/show/NCT01545232). The effect of the SBI is assessed on the primary PROPPR outcome, 24-hour and 30-day mortality. The distributions of blood storage ages successfully maps to a parameter (SBI) that fully defines the blood age curve for each patient. SBI was a significant predictor of 24-hour and 30-day mortality in an adjusted model that had strong predictive ability (odds ratio, 1.15 [1.01-1.29], p = 0.029, C-statistic, 0.81; odds ratio, 1.14 [1.02-1.28], p = 0.019, C-statistic, 0.88, respectively). SBI is a simple scalar metric of blood age that accounts for the relative distribution of RBCs among age categories. Transfusion of older RBCs is associated with 24-hour and 30-day mortality, after adjustment for total units and clinical covariates. © 2019 AABB.

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