赤血球輸血後の医療関連感染症:体系的なレビューとメタ解析
Jeffrey M Rohde1, Derek E Dimcheff1, Neil Blumberg2
1University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor.
JAMA
|April 3, 2014
まとめ
制限的な赤血球 (RBC) 輸血戦略は,リベラルなアプローチと比較して,入院患者における深刻な感染症のリスクを大幅に低下させた. この発見は,制限的な戦略が,医療関連感染症の割合を低下させることを示唆しています.
科学分野:
- 輸血医学とは
- 感染症疫学 感染症疫学
- 臨床試験分析 臨床試験分析について
背景:
- 赤血球 (RBC) 輸血の実践と医療関連感染症 (HAI) の関係については,さらなる明確化が必要である.
- 輸血値と白血球減少が感染リスクに与える影響を理解することは,患者の安全にとって極めて重要です.
研究 の 目的:
- 制限的対リベラルRBC輸血戦略とHAIを発症するリスクとの関連性を調査する.
- この関連が白血球減少の赤血球から独立しているかどうかを判断する.
主な方法:
- 制限的およびリベラルな赤血球輸血戦略を比較したランダム化臨床試験の体系的なレビューとメタ解析.
- 複数のデータベース (MEDLINE,EMBASEなど) で検索しました. 関連する試験については,2014年1月までとなります.
- プールされたリスク比率と感染の絶対リスクは,ランダム効果モデルを使用して計算されました.
主要な成果:
- 制限的な赤血球輸血戦略は,深刻な感染症のリスクが著しく低下した (リスク比 (RR) = 0.82;95%CI,0.72-0.95).
- 1つの重症感染症を予防するために,制限的な戦略で治療する (NNT) 必要な人数は38人でした.
- 制限戦略による感染リスクの低下は,白血球量が減少した血液製品でも観察され,特に整形外科の患者およびセプシス患者で顕著でした.
結論:
- 制限的な赤血球輸血戦略は,入院患者におけるHAIの発生率の低下と関連しています.
- 制限的な輸血プロトコルの実施は,HAI率を減らすための効果的な方法かもしれません.
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