Evaluation of Risk Factors on Red Blood Cells Transfusion for Patients Underwent Coronary Artery Bypass Grafting Perioperatively_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENLiang , LYVLin , LONGCun ,  LOUSong

Department of Extracorporeal Circulation, Fu wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding?author：

LOUSong, Email: lousongfw@163.com

Keywords：

Coronary artery bypass grafting; Red blood cells transfusion; Risk factor; Blood conservation

DOI：

10.7507/1007-4848.20160158

Video：

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Objective To investigate the risk factors of perioperative red blood cells transfusion for coronary artery bypass grafting (CABG) surgery. Method We retrospectively analyzed the clinical data of 534 patients underwent CABG in our hospital from January to March 2014 year. Those patients were divided into two groups:an on-pump coronary artery bypass grafting group (on-pump group) and an off-pump coronary artery bypass grafting group (off-pump group). There were 185 males and 54 females with a mean age of 59.1±9.4 years in the on-pump group. There were 233 males and 62 females with a mean age of 60.3±8.5 years in the off-pump group. Preoperative data, the relative parameters of extracorporeal circulation, the quantity of red blood cells transfusion of those two groups were compared. risk factors associated with red blood cells transfusion were evaluated by multivariate logistic regression analysis. Results The risk factors of perioperative red blood cells transfusion were age (OR=1.04, 95% CI 1.02-1.07, P=0.001) , weight (OR=0.95, 95% CI 0.93-0.97, P<0.001) , smoking (OR=0.61, 95% CI 0.39-0.94, P=0.027) , preoperative level of HCT (OR=0.90, 95% CI 0.85-0.96, P=0.001) and cardiopulmonary bypass (CPB) (OR=4.90, 95% CI 3.11-7.71, P<0.001) . During CPB, the nadir hemoglobin (nHb) (OR=0.63, 95% CI 0.47-0.84, P=0.002) was the only independent risk factor of red blood cell transfusion. Conclusions Age, weight, non-smoking, preoperative level of HCT, CPB are the risk factors for patients underwent CABG perioperatively and the lowest level of Hb in CPB is an independent risk factor of perioperative red blood cells transfusion.

Citation： CHENLiang, LYVLin, LONGCun, LOUSong. Evaluation of Risk Factors on Red Blood Cells Transfusion for Patients Underwent Coronary Artery Bypass Grafting Perioperatively. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 653-657. doi: 10.7507/1007-4848.20160158 Copy

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4.	周玉嬌, 于坤. 體外循環紅細胞損傷的原因、表現及危害. 中國體外循環雜志, 2015, 13(1) :61-64.
5.	Shander A, Javidroozi M, Ozawa S, et al. What is really dangerous:anaemia or transfusion? Br J Anaesth, 2011, 107(Suppl 1) :i 41-59.
6.	Santos AA, Sousa AG, Thomé HO, et al. Impact on early and late mortality after blood transfusion in coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc, 2013, 28(1) :1-9.
7.	Mohnle P, Snyder-Ramos SA, Miao Y, et al. Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med, 2011, 37:97-109.
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10.	Bennett-Guerrero E, Zhao Y, O'Brien SM, et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA, 2010, 304:1568-1575.
11.	邢萬紅, 徐志偉. 無血外科及其在心臟外科的應用. 中國胸心血管外科臨床雜志, 2013, 20(6) :719-722.
12.	Vonk AB, Meesters MI, van Dijk WB, et al. Ten-year patterns in blood product utilization during cardiothoracic surgery with cardiopulmonary bypass in a tertiary hospital. Transfusion, 2014, 54(10 Pt 2) :2608-2616.
13.	Likosky DS, Al-Attar PM, Malenka DJ, et al. Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2014, 148(6) :3084-3089.
14.	吳慧, 胡盛壽, 鄭哲, 等. 單純冠狀動脈旁路移植術患者圍術期輸血的危險因素分析. 中國輸血雜志, 2012, 25(4) :336-340.
15.	Sá MP, Soares EF, Santos CA, et al. Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc, 2011, 26(4) :552-558.
16.	Elmistekawy EM, Errett L, Fawzy HF. Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting:The experience of a single cardiac center:A prospective observational study. J Cardiothorac Surg, 2009, 4:20.
17.	Levy JH. The effects of cardiopulmonary bypass on coagulation. Clin Adv Hematol Oncol, 2013, 11(9) :589-591.
18.	Souza HJB, Moitinho RF. Strategies to reduce the use of blood components in cardiovascular surgery. Rev Bras Cir Cardiovasc, 2008, 23(1) :53-59.
19.	Miri-Moghaddam E, Mirzaei R, Arab MR, et al. The effects of water pipe smoking on hematological parameters in rats. Int J Hematol Oncol Stem Cell Res, 2014, 8(3) :37-43.
20.	Anandha LS, Lakshmanan A, Ganesh KP, et al. Effect of intensity of cigarette smoking on haematological and lipid parameters. J Clin Diagn Res, 2014, 8(7) :BC11-13.
21.	De Santo LS, Amarelli C, Della CA, et al. Blood transfusion after on-pump coronary artery bypass grafting:focus on modifiable risk factors. Eur J Cardiothorac Surg, 2013, 43(2) :359-366.

1. 陳良, 樓松, 龍村. 心臟外科圍手術期紅細胞輸血的研究進展. 中華胸心血管外科雜志, 2014, 30(12) :761-765.
2. Victor A, Ferraris JR, Brown GJ, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg, 2011, 91(3) :944-982.
3. 沈如華, 嚴中亞, 吳一軍, 等. EuroSCORE高危患者行心臟不停跳冠狀動脈旁路移植術的獲益. 中國胸心血管外科臨床雜志, 2014, 21(5) :604-608.
4. 周玉嬌, 于坤. 體外循環紅細胞損傷的原因、表現及危害. 中國體外循環雜志, 2015, 13(1) :61-64.
5. Shander A, Javidroozi M, Ozawa S, et al. What is really dangerous:anaemia or transfusion? Br J Anaesth, 2011, 107(Suppl 1) :i 41-59.
6. Santos AA, Sousa AG, Thomé HO, et al. Impact on early and late mortality after blood transfusion in coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc, 2013, 28(1) :1-9.
7. Mohnle P, Snyder-Ramos SA, Miao Y, et al. Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med, 2011, 37:97-109.
8. Shaw RE, Johnson CK, Ferrari G, et al. Balancing the benefits and risks of blood transfusions in patients undergoing cardiac surgery:a propensity-matched analysis. Interact Cardiovasc Thorac Surg, 2013, 17:96-102.
9. Shehata N, Naglie G, Alghamdi AA, et al. Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery:a systematic review. Vox Sang, 2007, 93(1) :1-11.
10. Bennett-Guerrero E, Zhao Y, O'Brien SM, et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA, 2010, 304:1568-1575.
11. 邢萬紅, 徐志偉. 無血外科及其在心臟外科的應用. 中國胸心血管外科臨床雜志, 2013, 20(6) :719-722.
12. Vonk AB, Meesters MI, van Dijk WB, et al. Ten-year patterns in blood product utilization during cardiothoracic surgery with cardiopulmonary bypass in a tertiary hospital. Transfusion, 2014, 54(10 Pt 2) :2608-2616.
13. Likosky DS, Al-Attar PM, Malenka DJ, et al. Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2014, 148(6) :3084-3089.
14. 吳慧, 胡盛壽, 鄭哲, 等. 單純冠狀動脈旁路移植術患者圍術期輸血的危險因素分析. 中國輸血雜志, 2012, 25(4) :336-340.
15. Sá MP, Soares EF, Santos CA, et al. Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc, 2011, 26(4) :552-558.
16. Elmistekawy EM, Errett L, Fawzy HF. Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting:The experience of a single cardiac center:A prospective observational study. J Cardiothorac Surg, 2009, 4:20.
17. Levy JH. The effects of cardiopulmonary bypass on coagulation. Clin Adv Hematol Oncol, 2013, 11(9) :589-591.
18. Souza HJB, Moitinho RF. Strategies to reduce the use of blood components in cardiovascular surgery. Rev Bras Cir Cardiovasc, 2008, 23(1) :53-59.
19. Miri-Moghaddam E, Mirzaei R, Arab MR, et al. The effects of water pipe smoking on hematological parameters in rats. Int J Hematol Oncol Stem Cell Res, 2014, 8(3) :37-43.
20. Anandha LS, Lakshmanan A, Ganesh KP, et al. Effect of intensity of cigarette smoking on haematological and lipid parameters. J Clin Diagn Res, 2014, 8(7) :BC11-13.
21. De Santo LS, Amarelli C, Della CA, et al. Blood transfusion after on-pump coronary artery bypass grafting:focus on modifiable risk factors. Eur J Cardiothorac Surg, 2013, 43(2) :359-366.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Evaluation of Risk Factors on Red Blood Cells Transfusion for Patients Underwent Coronary Artery Bypass Grafting Perioperatively

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