Effects of red-cell storage duration on patients undergoing cardiac surgery

Marie E. Steiner, Paul M. Ness, Susan F. Assmann, Darrell J. Triulzi, Steven R. Sloan, Meghan Delaney, Suzanne Granger, Elliott Bennett-Guerrero, Morris A. Blajchman, Vincent Scavo, Jeffrey L. Carson, Jerrold H. Levy, Glenn Whitman, Pamela D'Andrea, Shelley Pulkrabek, Thomas L. Ortel, Larissa Bornikova, Thomas Raife, Kathleen E. Puca, Richard M. KaufmanGregory A. Nuttall, Pampee P. Young, Samuel Youssef, Richard Engelman, Philip E. Greilich, Ronald Miles, Cassandra D. Josephson, Arthur Bracey, Rhonda Cooke, Jeffrey McCullough, Robert Hunsaker, Lynne Uhl, Janice G. McFarland, Yara Park, Melissa M. Cushing, Charles T. Klodell, Ravindra Karanam, Pamela R. Roberts, Cornelius Dyke, Eldad A. Hod, Christopher P. Stowell

Research output: Contribution to journalArticle

260 Citations (Scopus)

Abstract

BACKGROUND: Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. METHODS: We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. RESULTS: The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, -0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (P = 0.43); 28-day mortality was 4.4% and 5.3%, respectively (P = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. CONCLUSIONS: The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery.

Original languageEnglish (US)
Pages (from-to)1419-1429
Number of pages11
JournalNew England Journal of Medicine
Volume372
Issue number15
DOIs
StatePublished - Apr 9 2015

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Thoracic Surgery
Multiple Organ Failure
Organ Dysfunction Scores
Hyperbilirubinemia
Mortality
Observational Studies
Leukocytes
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Steiner, M. E., Ness, P. M., Assmann, S. F., Triulzi, D. J., Sloan, S. R., Delaney, M., ... Stowell, C. P. (2015). Effects of red-cell storage duration on patients undergoing cardiac surgery. New England Journal of Medicine, 372(15), 1419-1429. https://doi.org/10.1056/NEJMoa1414219

Effects of red-cell storage duration on patients undergoing cardiac surgery. / Steiner, Marie E.; Ness, Paul M.; Assmann, Susan F.; Triulzi, Darrell J.; Sloan, Steven R.; Delaney, Meghan; Granger, Suzanne; Bennett-Guerrero, Elliott; Blajchman, Morris A.; Scavo, Vincent; Carson, Jeffrey L.; Levy, Jerrold H.; Whitman, Glenn; D'Andrea, Pamela; Pulkrabek, Shelley; Ortel, Thomas L.; Bornikova, Larissa; Raife, Thomas; Puca, Kathleen E.; Kaufman, Richard M.; Nuttall, Gregory A.; Young, Pampee P.; Youssef, Samuel; Engelman, Richard; Greilich, Philip E.; Miles, Ronald; Josephson, Cassandra D.; Bracey, Arthur; Cooke, Rhonda; McCullough, Jeffrey; Hunsaker, Robert; Uhl, Lynne; McFarland, Janice G.; Park, Yara; Cushing, Melissa M.; Klodell, Charles T.; Karanam, Ravindra; Roberts, Pamela R.; Dyke, Cornelius; Hod, Eldad A.; Stowell, Christopher P.

In: New England Journal of Medicine, Vol. 372, No. 15, 09.04.2015, p. 1419-1429.

Research output: Contribution to journalArticle

Steiner, ME, Ness, PM, Assmann, SF, Triulzi, DJ, Sloan, SR, Delaney, M, Granger, S, Bennett-Guerrero, E, Blajchman, MA, Scavo, V, Carson, JL, Levy, JH, Whitman, G, D'Andrea, P, Pulkrabek, S, Ortel, TL, Bornikova, L, Raife, T, Puca, KE, Kaufman, RM, Nuttall, GA, Young, PP, Youssef, S, Engelman, R, Greilich, PE, Miles, R, Josephson, CD, Bracey, A, Cooke, R, McCullough, J, Hunsaker, R, Uhl, L, McFarland, JG, Park, Y, Cushing, MM, Klodell, CT, Karanam, R, Roberts, PR, Dyke, C, Hod, EA & Stowell, CP 2015, 'Effects of red-cell storage duration on patients undergoing cardiac surgery', New England Journal of Medicine, vol. 372, no. 15, pp. 1419-1429. https://doi.org/10.1056/NEJMoa1414219
Steiner ME, Ness PM, Assmann SF, Triulzi DJ, Sloan SR, Delaney M et al. Effects of red-cell storage duration on patients undergoing cardiac surgery. New England Journal of Medicine. 2015 Apr 9;372(15):1419-1429. https://doi.org/10.1056/NEJMoa1414219
Steiner, Marie E. ; Ness, Paul M. ; Assmann, Susan F. ; Triulzi, Darrell J. ; Sloan, Steven R. ; Delaney, Meghan ; Granger, Suzanne ; Bennett-Guerrero, Elliott ; Blajchman, Morris A. ; Scavo, Vincent ; Carson, Jeffrey L. ; Levy, Jerrold H. ; Whitman, Glenn ; D'Andrea, Pamela ; Pulkrabek, Shelley ; Ortel, Thomas L. ; Bornikova, Larissa ; Raife, Thomas ; Puca, Kathleen E. ; Kaufman, Richard M. ; Nuttall, Gregory A. ; Young, Pampee P. ; Youssef, Samuel ; Engelman, Richard ; Greilich, Philip E. ; Miles, Ronald ; Josephson, Cassandra D. ; Bracey, Arthur ; Cooke, Rhonda ; McCullough, Jeffrey ; Hunsaker, Robert ; Uhl, Lynne ; McFarland, Janice G. ; Park, Yara ; Cushing, Melissa M. ; Klodell, Charles T. ; Karanam, Ravindra ; Roberts, Pamela R. ; Dyke, Cornelius ; Hod, Eldad A. ; Stowell, Christopher P. / Effects of red-cell storage duration on patients undergoing cardiac surgery. In: New England Journal of Medicine. 2015 ; Vol. 372, No. 15. pp. 1419-1429.
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abstract = "BACKGROUND: Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. METHODS: We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. RESULTS: The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95{\%} confidence interval for the difference, -0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8{\%} in the shorter-term storage group and 2.0{\%} in the longer-term storage group (P = 0.43); 28-day mortality was 4.4{\%} and 5.3{\%}, respectively (P = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. CONCLUSIONS: The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery.",
author = "Steiner, {Marie E.} and Ness, {Paul M.} and Assmann, {Susan F.} and Triulzi, {Darrell J.} and Sloan, {Steven R.} and Meghan Delaney and Suzanne Granger and Elliott Bennett-Guerrero and Blajchman, {Morris A.} and Vincent Scavo and Carson, {Jeffrey L.} and Levy, {Jerrold H.} and Glenn Whitman and Pamela D'Andrea and Shelley Pulkrabek and Ortel, {Thomas L.} and Larissa Bornikova and Thomas Raife and Puca, {Kathleen E.} and Kaufman, {Richard M.} and Nuttall, {Gregory A.} and Young, {Pampee P.} and Samuel Youssef and Richard Engelman and Greilich, {Philip E.} and Ronald Miles and Josephson, {Cassandra D.} and Arthur Bracey and Rhonda Cooke and Jeffrey McCullough and Robert Hunsaker and Lynne Uhl and McFarland, {Janice G.} and Yara Park and Cushing, {Melissa M.} and Klodell, {Charles T.} and Ravindra Karanam and Roberts, {Pamela R.} and Cornelius Dyke and Hod, {Eldad A.} and Stowell, {Christopher P.}",
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TY - JOUR

T1 - Effects of red-cell storage duration on patients undergoing cardiac surgery

AU - Steiner, Marie E.

AU - Ness, Paul M.

AU - Assmann, Susan F.

AU - Triulzi, Darrell J.

AU - Sloan, Steven R.

AU - Delaney, Meghan

AU - Granger, Suzanne

AU - Bennett-Guerrero, Elliott

AU - Blajchman, Morris A.

AU - Scavo, Vincent

AU - Carson, Jeffrey L.

AU - Levy, Jerrold H.

AU - Whitman, Glenn

AU - D'Andrea, Pamela

AU - Pulkrabek, Shelley

AU - Ortel, Thomas L.

AU - Bornikova, Larissa

AU - Raife, Thomas

AU - Puca, Kathleen E.

AU - Kaufman, Richard M.

AU - Nuttall, Gregory A.

AU - Young, Pampee P.

AU - Youssef, Samuel

AU - Engelman, Richard

AU - Greilich, Philip E.

AU - Miles, Ronald

AU - Josephson, Cassandra D.

AU - Bracey, Arthur

AU - Cooke, Rhonda

AU - McCullough, Jeffrey

AU - Hunsaker, Robert

AU - Uhl, Lynne

AU - McFarland, Janice G.

AU - Park, Yara

AU - Cushing, Melissa M.

AU - Klodell, Charles T.

AU - Karanam, Ravindra

AU - Roberts, Pamela R.

AU - Dyke, Cornelius

AU - Hod, Eldad A.

AU - Stowell, Christopher P.

PY - 2015/4/9

Y1 - 2015/4/9

N2 - BACKGROUND: Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. METHODS: We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. RESULTS: The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, -0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (P = 0.43); 28-day mortality was 4.4% and 5.3%, respectively (P = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. CONCLUSIONS: The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery.

AB - BACKGROUND: Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. METHODS: We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. RESULTS: The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, -0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (P = 0.43); 28-day mortality was 4.4% and 5.3%, respectively (P = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. CONCLUSIONS: The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery.

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