The Influence of Homologous Blood Transfusion on Immunity and Clinical Outcome in Aortic Surgery
| Autor: | J. C. L. Wong, Sarah L. Haynes, Francesco Torella, Charles McCollum, K Dalrymple, L Pilsworth |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Transplantation Autologous Gastroenterology Transplantation Immunology Internal medicine Intensive care Confidence Intervals Odds Ratio medicine Humans Transplantation Homologous Blood Transfusion Prospective Studies Immune response Intraoperative Complications Prospective cohort study Aorta Survival analysis Aged Prolonged Surgery Medicine(all) biology business.industry Transfusion Elastase Odds ratio Middle Aged Prognosis Survival Analysis Middle age Surgery Logistic Models Treatment Outcome Neutrophil elastase Multivariate Analysis biology.protein Female Morbidity and mortality Inflammation Mediators Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Aortic surgery |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 22(3):244-250 |
| ISSN: | 1078-5884 |
| DOI: | 10.1053/ejvs.2001.1408 |
| Popis: | OBJECTIVES: To evaluate the influence of homologous blood transfusion on immune responses and post-operative morbidity in aortic surgery. DESIGN: Analysis of the effects of homologous blood transfusion in 128 patients in a prospective randomised trial evaluating homologous and autologous blood transfusion in aortic surgery. MATERIALS AND METHODS: Blood sampled before and at five times after surgery was assayed for C-reactive protein (CRP), neutrophil elastase, TNF-alpha and IL-6. Transfusions, morbidity and mortality were recorded; factors associated with poor outcome were identified by logistic regression. RESULTS: homologous transfusion during surgery was required in 32 patients and precipitated an increase in neutrophil elastase (p=0.008) and TNF-alpha (p=0.015) but not IL-6 and CRP. Elastase peaked early in transfused patients at 41.27 (13.92-52.11) Deltang/ml by 2 h compared to a peak of 21.51 (10.64-31.13) Deltang/ml by 24 h in those who were not transfused. TNF-alpha peaked at 1.2 (0-4.33) Deltapg/ml by wound closure in transfused patients and at -0.1 (-2.05-2.52) Deltapg/ml by 2 h without transfusion. Intra-operative homologous transfusion was associated with increased mortality (p=0.01) and prolonged intensive care stay (p=0.03). Mortality increased with age (p=0.003) and was inversely related to the CRP peak (p=0.007). Prolonged surgery predicted post-operative complications (p=0.025). CONCLUSION: Homologous transfusion increased the inflammatory response to aortic surgery and was associated with mortality. |
| Databáze: | OpenAIRE |
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