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Blood Transfusion: An Independent Risk Factor for Postinjury Multiple Organ Failure

Blood Transfusion: An Independent Risk Factor for Postinjury Multiple Organ Failure Abstract Objective: To determine if blood transfusion is a consistent risk factor for postinjury multiple organ failure (MOF), independent of other shock indexes. Design: A 55-month inception cohort study ending on August 30, 1995. Data characterizing postinjury MOF were prospectively collected. Multiple logistic regression analysis was performed on 5 sets of data. Set 1 included admission data (age, sex, comorbidity, injury mechanism, Glasgow Coma Scale, Injury Severity Score, and systolic blood pressure determined in the emergency department) plus the amount of blood transfused within the first 12 hours. In the subsequent 4 data sets, other indexes of shock (early base deficit, early lactate level, late base deficit, and late lactate level) were sequentially added. Additionally, the same multiple logistic regression analyses were performed with early MOF and late MOF as the outcome variables. Setting: Denver General Hospital, Denver, Colo, is a regional level I trauma center. Patients: Five hundred thirteen consecutive trauma patients admitted to the trauma intensive care unit with an Injury Severity Score greater than 15 who were older than 16 years and who survived longer than 48 hours. Interventions: None. Main Outcome Measures: The relationship of blood transfusions and other shock indexes with the outcome variable, MOF. Results: A dose-response relationship between early blood transfusion and the later development of MOF was identified. Despite the inclusion of other indexes of shock, blood transfusion was identified as an independent risk factor in 13 of the 15 multiple logistic regression models tested; the odds ratios were high, especially in the early MOF models. Conclusion: Blood transfusion is an early consistent risk factor for postinjury MOF, independent of other indexes of shock.Arch Surg. 1997;132:620-625 References 1. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA, Lezotte DC. Early predictors of postinjury multiple organ failure . Arch Surg . 1994;129:39-45.Crossref 2. Sauaia A, Moore FA, Moore EE, Lezotte DC. Early risk factors for postinjury multiple organ failure . World J Surg . 1996;20:392-400.Crossref 3. Moore FA, Sauaia A, Moore EE, Haenel JB, Burch JM, Lezotte DC. Postinjury multiple organ failure: a bimodal phenomenon . J Trauma . 1996;40:501-512.Crossref 4. Moore FA, Moore EE. Evolving concepts in the pathogenesis of postinjury multiple organ failure . Surg Clin North Am . 1995;75:257-277. 5. Moore FA, Haenel JB, Moore EE, et al. Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure . J Trauma . 1992;33:58-71.Crossref 6. Botha AJ, Moore FA, Moore EE, et al. Early neutrophil sequestration after injury: a pathogenic mechanism for multiple organ failure . J Trauma . 1995;39:411-417.Crossref 7. Botha AJ, Moore FA, Moore EE, et al. Early postinjury neutrophil priming and activation: a vulnerable window . Surgery . 1995;118:358-365.Crossref 8. Koike K, Moore EE, Moore FA, et al. Gut phospholipase A2 mediates neutrophil priming and lung injury after mesenteric ischemia-reperfusion . Am J Physiol . 1995;268:G397-G402. 9. Botha AJ, Moore FA, Moore EE, Peterson CM, Silliman CC, Goode AW. Sequential systemic platelet-activating factor and interleukin 8 primes neutrophils in patients with trauma at risk of multiple organ failure . Br J Surg . 1996; 83:1407-1412.Crossref 10. Partrick DA, Moore EE, Barnett CC, Silliman CC. Human polymerized hemoglobin as a blood substitute avoids transfusion-induced neutrophil priming . Surg Forum . 1996;47:36-38. 11. Silliman CC, Clay KL, Thurman GW, Johnson CA, Ambruso DR. Partial characterization of lipids that develop during the routine storage of blood and prime the neutrophil NADPH oxidase . J Lab Clin Med . 1994;124:684-694. 12. Silliman CC, Paterson AJ, Dickey WO, et al. The association of biologically active lipids with the development of transfusion related acute lung injury: a retrospective study. Transfusion. In press. 13. Partrick DA, Moore FA, Moore EE, et al. The inflammatory profile of interleukin-6, interleukin-8, and soluble intercellular adhesion molecule–1 in postinjury multiple organ failure . Am J Surg . 1996;172:425-431.Crossref 14. Stack G, Snyder EL. Cytokine generation in stored platelet concentrates . Transfusion . 1994;34:20-25.Crossref 15. Partrick DA, Moore EE, Moore FA, Biffl WL, Barnett CC. Reduced PAF-acetylhydrolase activity is associated with postinjury multiple organ failure . Shock . 1997;7:170-174.Crossref 16. Partrick DA, Moore FA, Moore EE, et al. Neutrophil priming and activation in the pathogenesis of postinjury multiple organ failure . New Horiz . 1996;4:194-210. 17. Dawson-Sanders B, Trapp RG. Basic and Clinical Biostatistics . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1994. 18. Hosmer DW, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1989. 19. Hill AB. Principles of Medical Statistics . New York, NY: Oxford University Press Inc; 1971. 20. Opelz G, Henneman IPH, Ruigrok M, et al. Improvement of kidney-graft survival with increased numbers of blood transfusion . N Engl J Med . 1978:299: 799-803.Crossref 21. Tartter P. The association of perioperative blood transfusion with colorectal cancer recurrence . Ann Surg . 1992;216:633-638.Crossref 22. Edna TH, Bjerkeset T. Association between blood transfusion and infection in injured patients . J Trauma . 1992;33:659-661.Crossref 23. Waydhas C, Nost-Kolb D, Jochum M, et al. Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma . Arch Surg . 1992;127:460-467.Crossref 24. Sauaia A, Moore FA, Moore EE, et al. Pneumonia: cause or symptom of postinjury multiple organ failure? Am J Surg . 1993;166:607-611.Crossref 25. Van Saene HKF, Stoutenbeek CC, Stoller JK. Selective decontamination of the digestive tract in the intensive care unit: current status and future prospects . Crit Care Med . 1992;20:691-703.Crossref 26. Heyland DK, Cook DJ, Jaeschke A, et al. Selective decontamination of the digestive tract: an overview . Chest . 1994;105:1221-1229.Crossref 27. Cerra FB, Maddaus MA, Dunn DL, et al. Selective gut decontamination reduces nosocomial infections and length of stay, but not mortality or organ failure in surgical intensive care unit patients . Arch Surg . 1992;127:163-169.Crossref 28. Gould SA, Moore EE, Moore FA, et al. The clinical utility of human polymerized hemoglobin as a blood substitute following trauma and emergency surgery. J Trauma.; In press. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Blood Transfusion: An Independent Risk Factor for Postinjury Multiple Organ Failure

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430300062013
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine if blood transfusion is a consistent risk factor for postinjury multiple organ failure (MOF), independent of other shock indexes. Design: A 55-month inception cohort study ending on August 30, 1995. Data characterizing postinjury MOF were prospectively collected. Multiple logistic regression analysis was performed on 5 sets of data. Set 1 included admission data (age, sex, comorbidity, injury mechanism, Glasgow Coma Scale, Injury Severity Score, and systolic blood pressure determined in the emergency department) plus the amount of blood transfused within the first 12 hours. In the subsequent 4 data sets, other indexes of shock (early base deficit, early lactate level, late base deficit, and late lactate level) were sequentially added. Additionally, the same multiple logistic regression analyses were performed with early MOF and late MOF as the outcome variables. Setting: Denver General Hospital, Denver, Colo, is a regional level I trauma center. Patients: Five hundred thirteen consecutive trauma patients admitted to the trauma intensive care unit with an Injury Severity Score greater than 15 who were older than 16 years and who survived longer than 48 hours. Interventions: None. Main Outcome Measures: The relationship of blood transfusions and other shock indexes with the outcome variable, MOF. Results: A dose-response relationship between early blood transfusion and the later development of MOF was identified. Despite the inclusion of other indexes of shock, blood transfusion was identified as an independent risk factor in 13 of the 15 multiple logistic regression models tested; the odds ratios were high, especially in the early MOF models. Conclusion: Blood transfusion is an early consistent risk factor for postinjury MOF, independent of other indexes of shock.Arch Surg. 1997;132:620-625 References 1. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA, Lezotte DC. Early predictors of postinjury multiple organ failure . Arch Surg . 1994;129:39-45.Crossref 2. Sauaia A, Moore FA, Moore EE, Lezotte DC. Early risk factors for postinjury multiple organ failure . World J Surg . 1996;20:392-400.Crossref 3. Moore FA, Sauaia A, Moore EE, Haenel JB, Burch JM, Lezotte DC. Postinjury multiple organ failure: a bimodal phenomenon . J Trauma . 1996;40:501-512.Crossref 4. Moore FA, Moore EE. Evolving concepts in the pathogenesis of postinjury multiple organ failure . Surg Clin North Am . 1995;75:257-277. 5. Moore FA, Haenel JB, Moore EE, et al. Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure . J Trauma . 1992;33:58-71.Crossref 6. Botha AJ, Moore FA, Moore EE, et al. Early neutrophil sequestration after injury: a pathogenic mechanism for multiple organ failure . J Trauma . 1995;39:411-417.Crossref 7. Botha AJ, Moore FA, Moore EE, et al. Early postinjury neutrophil priming and activation: a vulnerable window . Surgery . 1995;118:358-365.Crossref 8. Koike K, Moore EE, Moore FA, et al. Gut phospholipase A2 mediates neutrophil priming and lung injury after mesenteric ischemia-reperfusion . Am J Physiol . 1995;268:G397-G402. 9. Botha AJ, Moore FA, Moore EE, Peterson CM, Silliman CC, Goode AW. Sequential systemic platelet-activating factor and interleukin 8 primes neutrophils in patients with trauma at risk of multiple organ failure . Br J Surg . 1996; 83:1407-1412.Crossref 10. Partrick DA, Moore EE, Barnett CC, Silliman CC. Human polymerized hemoglobin as a blood substitute avoids transfusion-induced neutrophil priming . Surg Forum . 1996;47:36-38. 11. Silliman CC, Clay KL, Thurman GW, Johnson CA, Ambruso DR. Partial characterization of lipids that develop during the routine storage of blood and prime the neutrophil NADPH oxidase . J Lab Clin Med . 1994;124:684-694. 12. Silliman CC, Paterson AJ, Dickey WO, et al. The association of biologically active lipids with the development of transfusion related acute lung injury: a retrospective study. Transfusion. In press. 13. Partrick DA, Moore FA, Moore EE, et al. The inflammatory profile of interleukin-6, interleukin-8, and soluble intercellular adhesion molecule–1 in postinjury multiple organ failure . Am J Surg . 1996;172:425-431.Crossref 14. Stack G, Snyder EL. Cytokine generation in stored platelet concentrates . Transfusion . 1994;34:20-25.Crossref 15. Partrick DA, Moore EE, Moore FA, Biffl WL, Barnett CC. Reduced PAF-acetylhydrolase activity is associated with postinjury multiple organ failure . Shock . 1997;7:170-174.Crossref 16. Partrick DA, Moore FA, Moore EE, et al. Neutrophil priming and activation in the pathogenesis of postinjury multiple organ failure . New Horiz . 1996;4:194-210. 17. Dawson-Sanders B, Trapp RG. Basic and Clinical Biostatistics . 2nd ed. East Norwalk, Conn: Appleton & Lange; 1994. 18. Hosmer DW, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1989. 19. Hill AB. Principles of Medical Statistics . New York, NY: Oxford University Press Inc; 1971. 20. Opelz G, Henneman IPH, Ruigrok M, et al. Improvement of kidney-graft survival with increased numbers of blood transfusion . N Engl J Med . 1978:299: 799-803.Crossref 21. Tartter P. The association of perioperative blood transfusion with colorectal cancer recurrence . Ann Surg . 1992;216:633-638.Crossref 22. Edna TH, Bjerkeset T. Association between blood transfusion and infection in injured patients . J Trauma . 1992;33:659-661.Crossref 23. Waydhas C, Nost-Kolb D, Jochum M, et al. Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma . Arch Surg . 1992;127:460-467.Crossref 24. Sauaia A, Moore FA, Moore EE, et al. Pneumonia: cause or symptom of postinjury multiple organ failure? Am J Surg . 1993;166:607-611.Crossref 25. Van Saene HKF, Stoutenbeek CC, Stoller JK. Selective decontamination of the digestive tract in the intensive care unit: current status and future prospects . Crit Care Med . 1992;20:691-703.Crossref 26. Heyland DK, Cook DJ, Jaeschke A, et al. Selective decontamination of the digestive tract: an overview . Chest . 1994;105:1221-1229.Crossref 27. Cerra FB, Maddaus MA, Dunn DL, et al. Selective gut decontamination reduces nosocomial infections and length of stay, but not mortality or organ failure in surgical intensive care unit patients . Arch Surg . 1992;127:163-169.Crossref 28. Gould SA, Moore EE, Moore FA, et al. The clinical utility of human polymerized hemoglobin as a blood substitute following trauma and emergency surgery. J Trauma.; In press.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1997

References

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