急诊室贫血患者(70-90 g.L-1)住院期间输血与否:一项单中心倾向匹配研究。

Fabien Coisy, Clemence Anselme, Radjiv Goulabchand, Laura Grau-Mercier, Thibaut Markarian, Xavier Bobbia, Romain Genre-Grandpierre
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摘要

背景和重要性:在急诊科(ED)就诊的患者中,有四分之一患有贫血。虽然输注红细胞(RBC)是治疗症状性贫血的常规方法,但没有证据表明急诊科血流动力学稳定的患者输血对需要住院治疗的患者有益。研究目的该研究旨在比较在急诊室输血或不输血的 70 至 90 g.L-1 贫血患者的住院时间(LOS):设计:回顾性单中心研究 设置和参与者:本大学医院急诊科收治的所有成人患者,初始血红蛋白水平在 70 至 90 g.L-1 之间,无失血性休克,急诊科收治后住院。结果测量与分析:由血红蛋白水平、Charlsons合并症指数、贫血的临床表现、贫血的慢性程度和住院部门组成的倾向评分用于比较急诊室输血与不输血患者的生命周期:干预措施:在急诊室输注红细胞:从2022年1月1日至12月31日,共筛查了1 169名患者,其中569人(49%)被排除在外,主要原因是出院后未住院治疗。其余 564 名(48%)患者的中位年龄为 77 [68; 85],240 名(43%)为女性。最后,127 名(23%)患者在急诊室接受了输血。输血患者在整个住院期间接受的红细胞单位数比非输血患者多(4 [3; 5] 对 2 [1; 3](p< 0.01))。经过倾向评分匹配后,急诊室输血患者的中位住院日为 9 [5; 19] 天,非急诊室输血患者的中位住院日为 8 [5; 15] 天(中位差异=-1 95% CI [-3; 2];p= 0.45)。结论对于非危及生命的贫血患者,与在住院部输血相比,在急诊室输注红细胞似乎不会缩短住院时间。需要进一步研究以确定需要在急诊室输血的患者。
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In-hospital stay of anemic patients (70-90 g.L-1) in the ED with/without transfusion: a single-center propensity-matched study.
Background and importance: A quarter of patients presenting to the emergency department (ED) have anemia. Although red blood cell (RBC) transfusion is routinely used in symptomatic anemia, there is no evidence on the benefit of blood transfusion in hemodynamically stable patients in the ED for patients requiring hospitalization. Objective: The study aimed to compare in-hospital length of stay (LOS) of patients with anemia between 70 and 90 g.L-1 transfused or not in ED. Design : Retrospective single-center study Settings and participants: All adult patients admitted to the ED of our university hospital with an initial hemoglobin level between 70 and 90 g.L-1, without hemorrhagic shock, who were hospitalized after ED admission. Outcome measures and analysis: A propensity score, comprising hemoglobin level, Charlsons comorbidity index, clinical signs of anemia, the chronicity of anemia and hospitalization department was used to compare the LOS of patients transfused versus non-transfused in the ED. Intervention: RBC transfusion in the ED Main results: From January 1st to December 31st, 2022, 1 169 patients were screened of whom 569 (49%) were excluded, mostly due to discharge without hospitalization. The remaining 564 (48%) patients had a median age of 77 [68; 85] and 240 (43%) were women. Finally, 127 (23%) patients were transfused in ED. Transfused patients received more units of RBC during the whole hospitalization period (4 [3; 5] versus 2 [1; 3] than non-transfused patients (p< 0.01)). After propensity score matching, median LOS was 9 [5; 19] days for ED transfused patients and 8 [5; 15] days for non-ED transfused patients (median difference= -1 95% CI [-3; 2]; p= 0.45). Conclusion: In patients with non-life-threatening anemia, RBC transfusion in the ED does not appear to reduce in-hospital LOS compared with transfusion in inpatient departments. Further studies are needed to identify patients requiring transfusion in ED.
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