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

1.	陈良, 楼松, 龙村. 心脏外科围手术期红细胞输血的研究进展. 中华胸心血管外科杂志, 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.	沈如华, 严中亚, 吴一军, 等. EuroSCORE高危患者行心脏不停跳冠状动脉旁路移植术的获益. 中国胸心血管外科临床杂志, 2014, 21(5) :604-608.
4.	周玉娇, 于坤. 体外循环红细胞损伤的原因、表现及危害. 中国体外循环杂志, 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.	邢万红, 徐志伟. 无血外科及其在心脏外科的应用. 中国胸心血管外科临床杂志, 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.	吴慧, 胡盛寿, 郑哲, 等. 单纯冠状动脉旁路移植术患者围术期输血的危险因素分析. 中国输血杂志, 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. 陈良, 楼松, 龙村. 心脏外科围手术期红细胞输血的研究进展. 中华胸心血管外科杂志, 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. 沈如华, 严中亚, 吴一军, 等. EuroSCORE高危患者行心脏不停跳冠状动脉旁路移植术的获益. 中国胸心血管外科临床杂志, 2014, 21(5) :604-608.
4. 周玉娇, 于坤. 体外循环红细胞损伤的原因、表现及危害. 中国体外循环杂志, 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. 邢万红, 徐志伟. 无血外科及其在心脏外科的应用. 中国胸心血管外科临床杂志, 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. 吴慧, 胡盛寿, 郑哲, 等. 单纯冠状动脉旁路移植术患者围术期输血的危险因素分析. 中国输血杂志, 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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