Duration of red blood cell storage and survival of transfused patients (CME)
Correction(s) for this article
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CORRECTION
- Volume 50Issue 8Transfusion
- pages: 1857-1857
- First Published online: August 2, 2010
Gustaf Edgren
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMads Kamper-Jørgensen
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorSandra Eloranta
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorKlaus Rostgaard
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorBrian Custer
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorHenrik Ullum
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorEdward L. Murphy
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMichael P. Busch
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMarie Reilly
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMads Melbye
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorHenrik Hjalgrim
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorAnd Olof Nyrén
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorGustaf Edgren
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMads Kamper-Jørgensen
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorSandra Eloranta
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorKlaus Rostgaard
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorBrian Custer
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorHenrik Ullum
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorEdward L. Murphy
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMichael P. Busch
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMarie Reilly
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorMads Melbye
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorHenrik Hjalgrim
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorAnd Olof Nyrén
From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
Search for more papers by this authorThis study was funded by the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health (N01-HB-47174). The creation of the SCANDAT database was funded by the National Heart, Lung, and Blood Institute and the National Cancer Institute of the U.S. National Institutes of Health (N01-CP-21175). GE has received funding through a postdoctoral stipend from Svenska Sällskapet för Medicinsk Forskning (SSMF). MKJ and HH have received funding from the Danish Medical Research Council (271-08-0831). ELM has received a career development award (K24-HL-75036) from the U.S. National Heart, Lung, and Blood Institute. The funding organization did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Abstract
BACKGROUND: Disquieting reports of increased complication and death rates after transfusions of red blood cells (RBCs) stored for more than 14 days prompted us to perform an observational retrospective cohort study of mortality in relation to storage time.
STUDY DESIGN AND METHODS: We conducted a cohort study utilizing data on all recipients of at least one RBC transfusion in Sweden and Denmark between 1995 and 2002, as recorded in the Scandinavian Donations and Transfusions (SCANDAT) database. Relative risks of death in relation to storage time were estimated using Cox regression, adjusted for several possible confounding factors.
RESULTS: After various exclusions, 404,959 transfusion episodes remained for analysis. The 7-day risk of death was similar in all exposure groups, but a tendency for a higher risk emerged among recipients of blood stored for 30 to 42 days (hazard ratio, 1.05; 95% confidence interval [CI], 0.97-1.12), compared to recipients of blood stored for 10 to 19 days. With 2-year follow-up, this excess remained at the same level (hazard ratio, 1.05; 95% CI, 1.02-1.08). No dose-response pattern was revealed and no differential effect was seen when the analyses were restricted to recipients of leukoreduced units only.
CONCLUSION: Although a small excess mortality was noted in recipients of the oldest RBCs, the risk pattern was more consistent with weak confounding than with an effect of the momentary exposure to stored RBCs. It seems, thus, that any excess mortality conferred by older RBCs in the combined Swedish and Danish transfusion recipient population is likely less than 5%, which is considerably smaller than in the hitherto largest investigation.
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