Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion

Heddle, Nancy M.; Cook, Richard J.; Arnold, Donald M.; Yang, Linhua; Barty, Rebecca; Crowther, Mark; Devereaux, P.J.; Hirsh, Jack; Warkentin, Theodore E.; Webert, Kathryn E.; Roxby, David; Sobieraj‐Teague, Magdalena; Kurz, Andrea; Sessler, Daniel I.; Figueroa, Priscilla; Ellis, Martin; Eikelboom, John W.

doi:10.1056/nejmoa1609014

Cited by 260 publications

(226 citation statements)

References 22 publications

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“…This result is unsurprising, given the results of the ABLE trial, which found no significant differences in the primary and secondary outcomes between treatment groups. 73 trial findings, the current evidence base does not support the routine or widespread use of fresher RBCs more than those provided as usual practice (with a mean storage age of 20-22 days).…”

Section: Comparison Of the Two Euroqol-5 Dimensions Versions For Assementioning

confidence: 67%

“…Another relevant trial, INFORM (INforming Fresh versus Old Red cell Management; ISRCTN08118744), 73 was published since the main publication describing the ABLE trial. This was a hospital-wide study randomising any patient requiring a RBC transfusion to receive the freshest versus the oldest available RBCs in the blood bank during their hospital stay in a 1 : 2 ratio.…”

Section: Results In Context Of Other Researchmentioning

confidence: 99%

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The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

Walsh

Stanworth

Boyd

et al. 2017

Health Technol Assess

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on behalf of the UK ABLE trial investigatorsThe Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost-utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up The full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/144/51. The contractual start date was in September 2011. The draft report began editorial review in September 2016 and was accepted for publication in April 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the int...

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Section: Comparison Of the Two Euroqol-5 Dimensions Versions For Assementioning

confidence: 67%

Section: Results In Context Of Other Researchmentioning

confidence: 99%

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

Walsh

Stanworth

Boyd

et al. 2017

Health Technol Assess

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“…There were no other differences in the secondary outcomes between groups in the ITT analysis. In the AT analysis, hospital LOS was longer in the old blood group than in the fresh blood group (11 [7][8][9][10][11][12][13][14][15][16][17][18][19][20] vs. 9 [6][7][8][9][10][11][12][13][14][15][16]; difference in means, -3.62; CI, -7.6 to -0.6; Table 4). …”

Section: Secondary Outcomesmentioning

confidence: 99%

“…5 Three recent randomized clinical trials did not find significant differences between fresh and old blood in patients undergoing cardiac surgery 6 or admitted to the intensive care unit (ICU) 7 and in hospitalized patients. 8 Immunosuppression induced by surgery and anesthesia may be aggravated by transfusion. 9 Most studies in trauma and cardiac surgery reported that prolonged RBC storage was a risk factor for postoperative infections after cardiac surgery, [10][11][12] but the same association was not found in liver transplantation 13 or orthopedic surgery.…”

mentioning

confidence: 99%

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

et al. 2017

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BACKGROUND: Prolonged storage of red blood cells (RBCs) is a potential risk factor for postoperative infections. The objective of this study was to examine the effect of age of RBCs transfused on development of postoperative infection. STUDY DESIGN AND METHODS: In thisprospective, double-blind randomized trial, 199 patients undergoing elective noncardiac surgery and requiring RBC transfusion were assigned to receive nonleukoreduced RBCs stored for not more than 14 days ("fresh blood" group, n 5 101) or for more than 14 days ("old blood" group, n 5 98). The primary outcome was occurrence of infection within 28 days after surgery; secondary outcomes were postoperative acute kidney injury (AKI), in-hospital and 90-day mortality, admission to intensive care unit, and hospital length of stay (LOS). As older blood was not always available, an "as-treated" (AT) analysis was also performed according to actual age of the RBCs transfused. RESULTS:The median [interquartile range] storage time of and 15 [11][12][13][14][15][16][17][18][19][20] days in fresh blood and in old blood groups, respectively. The occurrence of postoperative infection did not differ between groups (fresh blood 22% vs. old blood 25%; relative risk [RR], 1.17; confidence interval [CI], 0.71-1.93), although wound infections occurred more frequently in old blood (15% vs. 5%; RR, 3.09; CI,). Patients receiving older units had a higher rate of AKI (24% vs. 6%; p < 0.001) and, according to AT analysis, longer LOS (mean difference, 3.6 days; CI, 0.6-7.5).CONCLUSION: Prolonged RBC storage time did not increase the risk of postoperative infection. However, old blood transfusion increased wound infections rate and incidence of AKI. Immunosuppression induced by surgery and anesthesia may be aggravated by transfusion. 9 Most studies in trauma and cardiac surgery reported that prolonged RBC storage was a risk factor for postoperative infections after cardiac surgery, 10-12 but the same association was not found in liver transplantation 13 or orthopedic surgery. 14 A recent systematic review 15 that analyzed four trials which investigated the nosocomial infections, showed no benefits in receiving fresh RBCs. However, the authors reported that the results are difficult to interpret because the studies involved different populations and there were considerable differences in the length of storage of fresh and old blood and in study methods. 15To our knowledge, the association of age of RBCs with infections in noncardiac surgery population has not been investigated by double-blind randomized studies. Accordingly, the aim of this study was to investigate the relationship between RBC storage time and postoperative infection after elective noncardiac surgery. In addition, we evaluated the effects of the age of RBCs on other outcomes such as postoperative acute kidney injury (AKI), hospital length of stay (LOS), and 90-day mortality. MATERIALS AND METHODS Study populationThis prospective, randomized, controlled, double-blind clinical trial was conducted between August 2...

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“…One reason for this is that these studies have been limited by small sample sizes. Another reason is that the definition of fresh blood and aged blood has been inconsistent across studies ( Table 1) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Several articles have defined fresh blood as a function of time, ranging anywhere from 5 days (8) to 21 days (17), while others have taken a more practical approach, employing a "freshest available" policy (18,20).…”

mentioning

confidence: 99%

Age before duty: the effect of storage duration on mortality after red blood cell transfusion

2017

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Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion

Cited by 260 publications

References 22 publications

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

Age before duty: the effect of storage duration on mortality after red blood cell transfusion

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