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Universal leukocyte reduction of transfused red cells does not provide benefit to patients undergoing cardiac surgery
Leena Capraro1, Anne Kuitunen, Antti E Vento
1Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Insights
Universal leukocyte reduction of blood supply in Finland did not decrease postoperative infections or mortality in cardiac surgery patients. This policy did not improve outcomes like infection rates or intensive care unit stay duration.
Area of Science:
- Transfusion Medicine
- Infectious Disease Epidemiology
- Cardiovascular Surgery
Background:
- Finland implemented universal leukocyte reduction of the blood supply in 2003.
- Leukocyte reduction aims to decrease transfusion-related complications.
- The study evaluated the impact on postoperative infections following cardiac surgery.
Purpose of the Study:
- To determine if leukocyte-reduced red blood cells reduce postoperative infections after cardiac surgery.
- To assess the effect of universal leukocyte reduction on infection rates, mortality, and ICU stay.
Main Methods:
- Retrospective cohort study at a major university clinic.
- Compared patients undergoing cardiac surgery in 2002 (pre-leukocyte reduction) and 2003 (post-leukocyte reduction).
- Analyzed outcomes in transfused patients receiving buffy-coat-depleted vs. leukocyte-reduced red blood cells.
Main Results:
- Transfusion rates and amounts were comparable between groups.
- No significant differences were observed in 90-day mortality (6.6% vs. 6.3%) or culture-proven infection rates (8.8% vs. 10.9%).
- Length of intensive care unit stay also remained unchanged (3.6 vs. 4.3 days).
Conclusions:
- Universal leukocyte reduction in Finland did not demonstrate a beneficial effect on culture-positive infection rates in cardiac surgery patients.
- The policy did not significantly impact 90-day mortality or length of intensive care unit stay.
- Leukocyte reduction was not associated with reduced postoperative infections or mortality in this cohort.
Objective:
A policy of universal leukocyte reduction of the blood supply in Finland was implemented at the beginning of 2003. The aim of the present evaluation was to determine the potential role of leukocyte-reduced red blood cells in decreasing postoperative infections.
Design:
A retrospective cohort study.
Setting:
A major university clinic.
Participants:
Consecutive patients undergoing cardiac surgery during the years 2002 and 2003.
Interventions:
Transfused patients received either buffy-coat-depleted red blood cells before leukocyte reduction (n = 782) or leukocyte-reduced red blood cells after leukocyte reduction (n = 632).
Measurements And Main Results:
The evaluated outcome parameters were culture-proven postoperative infections, 90-day mortality, and length of stay in the intensive care unit. The percentage of patients transfused with red blood cells (56% v 53%, p = 0.16) and amounts of transfused red blood cells (4.3 +/- 6.7 [3.0] units v 4.3 +/- 6.6 [2.0] units, means +/- standard deviation [median], p = 0.48) were comparable between the study groups (buffy-coat-depleted group and leukocyte-reduced group, respectively). The 90-day mortality (6.6% v 6.3%, p = 0.28), the length of intensive care stay (3.6 +/- 4.7 [2.0] days v 4.3 +/- 7.1 [2.0] days, p = 0.34), and the number of patients with culture-proven infections (8.8% v 10.9%, p = 0.19) were unchanged after universal leukocyte reduction. In multivariate comparisons, the leukocyte reduction was not associated with culture-proven postoperative infections and 90-day mortality.
Conclusion:
No beneficial effect of the universal leukocyte reduction in cardiac surgery was found for culture-positive infection rates, 90-day mortality, or length of intensive care stay.
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