RESUMO
BACKGROUND: Patients who receive extracorporeal membrane oxygenation (ECMO) support require substantial transfusions. Red blood cell (RBC) and platelet (PLT) transfusions have been reported to be associated with adverse outcomes in ECMO patients. However, little is known about whether the transfusion of fresh frozen plasma (FFP) is associated with mortality and morbidity among patients receiving ECMO. The aim of this study was to examine the relationship between FFP transfusion and mortality in ECMO patients and assess risk factors for the transfusion of FFP. METHODS: The clinical parameters of 116 ECMO patients were collected. The machine learning approach of the Boruta algorithm was employed to select the variables associated with ECMO patients' in-hospital mortality. Univariate and multivariate logistic regression analyses were applied to identify the association between the selected variables and in-hospital mortality. Spearman correlation and backwards stepwise multiple linear regression analyses were used to examine parameters contributing to FFP transfusion. RESULTS: Among the 116 patients who received ECMO support, the in-hospital mortality was 32.8%. The median FFP (mL/kg/d) transfusion was higher in dead patients (5.07, IQR 1.78-8.90) when compared to alive patients (2.16, IQR 0.79-4.66) (p = 0.007). After adjustment for confounders, FFP transfusion (mL/kg/d) was associated with in-hospital mortality (OR 1.09, 95% CI, 1.01-1.18; p = 0.035). Further analysis found that higher activated partial thromboplastin time (APTT), higher levels of uric acid (UA) and lower PLT counts were significant risk factors for FFP transfusion, with estimated values of 0.06 (95% CI, 0.02-0.11; p = 0.009), 0.01 (95% CI, 0.00-0.02; p = 0.003) and -0.03 (95% CI, -0.05--0.01; p = 0.007), respectively. CONCLUSION: FFP transfusion is markedly associated with in-hospital mortality among patients receiving ECMO, and higher APTT, higher levels of UA and lower PLT counts are risk factors for FFP transfusion. This suggests that better management of patients' coagulation system and kidney function may reduce the utilization of FFP, thus improving ECMO patient outcomes.
RESUMO
Reference evapotranspiration (ET0) is important for agricultural production and the hydrological cycle. Knowledge of ET0 can aid the appropriate allocation of irrigation water in arid regions. This study analyzed the trends in ET0 over different timescales in the Tarim River basin (TRB), Central Asia. ET0 was calculated by the Penman-Monteith method using data from 1960-2017 from 30 meteorological stations located in the TRB. The Mann-Kendall (MK) test with trend-free prewhitening and Sen's slope estimator were applied to detect trends in ET0 variation. The results showed that the mean ET0 decreased at a rate of 0.49 mm·10 a-1 on an annual timescale. The mean ET0 exhibited a decreasing trend in summer and increasing trends in other seasons. The effects of climatic factors on ET0 were assessed by sensitivity analysis and contribution rate analysis. Maximum temperature (Tmax), relative humidity (RH) and wind speed (WS) showed important effects on ET0. However, WS, which decreased, was the key element that induced changes in ET0 in the TRB. This work provides an important baseline for the management of agricultural water resources and scientific planning in agriculture.