Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrome in pediatric intensive care patients

Authors

  • France Gauvin,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Philip C. Spinella,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Jacques Lacroix,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Ghassan Choker,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Thierry Ducruet,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Oliver Karam,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Paul C. Hébert,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • James S. Hutchison,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Heather A. Hume,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • Marisa Tucci,

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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  • on behalf of the Canadian Critical Care Trials Group and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

    1. From the Pediatric Critical Care and the Hematology-Oncology Division, Sainte-Justine Hospital and Université de Montréal, Montréal, Québec, Canada; the Pediatric Critical Care, Connecticut Children's Hospital, Hartford, Connecticut; the Critical Care Unit, Ottawa General Hospital, University of Ottawa, Ontario, Canada; and the Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Dr Marisa Tucci, Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal (Québec), Canada H3T 1C5; e-mail: marisa.tucci@recherche-ste-justine.qc.ca.

Abstract

BACKGROUND: The objective was to determine if there is an association between red blood cell (RBC) storage time and development of new or progressive multiple organ dysfunction syndrome (MODS) in critically ill children.

STUDY DESIGN AND METHODS: This was an analytic cohort analysis of patients enrolled in a randomized controlled trial, TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units; ISRCTN37246456), in which stable critically ill children were randomly assigned to a restrictive or liberal strategy. Transfused patients were analyzed using three different sliding time cutoffs (7, 14, and 21 days). Storage time for multiply transfused patients was defined according to the oldest unit transfused.

RESULTS: A total of 455 patients were retained (liberal, 310; restrictive, 145). Multivariate logistic regression was performed to determine independent associations. In the restrictive group, a maximum RBC storage time of more than 21 days was independently associated with new or progressive MODS (adjusted odds ratio [OR], 3.29; 95% confidence interval [CI], 1.21-9.04). The same association was found in the liberal group for a storage time of more than 14 days (adjusted OR, 2.50; 95% CI, 1.12-5.58). When the two groups were combined in a meta-analysis, a storage time of more than 14 days was independently associated with increased MODS (adjusted OR, 2.23; 95% CI, 1.20-4.15) and more than 21 days was associated with increased Pediatric Logistic Organ Dysfunction (PELOD) scores (adjusted mean difference, 4.26; 95% CI, 1.99-6.53) and higher mortality (9.2% vs. 3.8%).

CONCLUSION: Stable critically ill children who receive RBC units with storage times longer than 2 to 3 weeks may be at greater risk of developing new or progressive MODS.

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