Age of transfused blood is an independent risk factor for postinjury multiple organ failure

BACKGROUND: Blood transfusion has repeatedly been demonstrated to be an ind ependent risk factor for postinjury multiple organ failure (MOF). Previousl y believed to represent a surrogate for shock, packed red blood cell (PRBC) transfusion has recently been shown to result in neutrophil priming and pu lmonary endothelial cell activation. We have previously observed that the g eneration of inflammatory mediators is related to the length of PRBC unit s torage. The purpose of this study was to determine if age of transfused PRB C is a risk factor for the development of postinjury MOF. METHODS: Using our prospective database of trauma patients at risk for deve loping MOF, we identified patients who developed MOF (MOF+) and received 6 to 20 units of PRBCs in the first 12 hours following injury. A similar coho rt of patients, matched for ISS and transfusion requirement, who did not de velop MOF (MOF-) were also identified. The age of each unit of PRBC transfu sed in the first 6 hours was determined, Multiple logistic regression was p erformed to determine if age of transfused blood is an independent risk fac tor. RESULTS: Sixty-three patients were identified, 23 of whom were MOF+, There was no difference in ISS and transfusion requirement between MOF+ and MOF- groups. MOF+ patients, however, were significantly older (46 +/- 4.7 years versus 33 +/- 2.3 years). Moreover, mean age of transfused blood was greate r in the MOF+ patients (30.5 +/- 1.6 days versus 24 +/- 0.5 days). Similarl y, the mean number of units older than 14 and 21 days old were greater in t he MOF+ patients. Multivariate analysis identified mean age of blood, numbe r of units older than 14 days, and number of units older than 21 days as in dependent risk factors for MOF, CONCLUSION: The age of transfused PRBCs transfused in the first 6 hours is an independent risk factor for postinjury MOF, This suggests that current b lood bank processing and storage technique should be reexamined. Moreover, fresh blood may be more appropriate for the initial resuscitation of trauma patients requiring transfusion. Am J Surg, 1999;178:570-572, (C) 1999 by E xcerpta Medica, Inc.