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Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery

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Abstract

Objective

To identify associations among haemoglobin (Hb) concentrations, blood transfusions, and clinical outcomes in patients after cardiac surgery, especially in those who undergo valve replacement or bypass surgery.

Design

Prospective observational trial.

Setting

Surgical intensive care unit in a tertiary-level university hospital.

Patients

1216 Consecutive patients.

Measurements

Haemoglobin at admission and 6, 12, 24, and 48 h later, and then, every 24 h while patients remained in the intensive care unit (ICU); number of transfusions and clinical events.

Results

Patients were divided into quartiles according to minimal haemoglobin, the first and second of which (Hb <8.10 and <8.91 g/dL, respectively) differed significantly (P < 0.001) from the other two quartiles in terms of more organ failure, longer ICU stay, and higher mortality. We found associations between being transfused ≥4 packed red cells (PRCs) and a worse clinical outcome and higher mortality. The associated mortality rate was higher for patients who underwent bypass surgery when they had Hb ≤8.9 g/dL and for those who underwent valve replacement when they had Hb >8.9 g/dL and were transfused ≥4 PRCs.

Conclusions

Low haemoglobin concentrations and transfusions in patients undergoing cardiac surgery are associated with increased morbidity and mortality. Also, anemia and transfusions are associated with poor outcome. Therefore, intra- and postoperative bleeding seem to be a risk factor in patients undergoing cardiac surgery.

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References

  1. Leal-Noval SR, Rincon-Ferrari MD, Garcia-Curiel A, Herruzo-Aviles A, Camacho-Laraña P, Garnacho-Montero J, Amaya-Villar R (2001) Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest 119:1461–1468

    Article  PubMed  CAS  Google Scholar 

  2. Fransen E, Maessen J, Dentener M, Senden N, Buurman W (1999) Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery. Chest 116:1233–1239

    Article  PubMed  CAS  Google Scholar 

  3. Looney MR, Gropper MA, Matthay MA (2004) Transfusion-related acute lung injury: a review. Chest 128:249–258

    Article  Google Scholar 

  4. Spiess BD (2004) Risks of transfusion: outcome focus. Transfusion 44:S45–S145

    Article  Google Scholar 

  5. Levy MM, Abraham E, Zilberberg M, MacIntyre NR (2005) A descriptive evaluation of transfusion practices in patients receiving mechanical ventilation. Chest 127:928–935

    Article  PubMed  Google Scholar 

  6. Gong MN, Thomson BT, Williams P, Pothier L, Boyce PD, Christiani DC (2005) Clinical predictors of and mortality in acute respiratory distress syndrome. Potential role of red cell transfusion. Crit Care Med 33:1191–1198

    Article  PubMed  Google Scholar 

  7. Solheim BG (2007) Transfusion-related acute lung injury (TRALI)-the preventable danger in intensive care? Intensive Care Med 33:S1–S2

    Article  PubMed  Google Scholar 

  8. Sachs UJ (2007) Pathophysiology of TRALI: current concepts. Intensive Care Med 33:S3–S11

    Article  PubMed  Google Scholar 

  9. Wallis JP (2007) Transfusion-related acute lung injury (TRALI): presentation, epidemiology and treatment. Intensive Care Med 33:S12–S16

    Article  PubMed  Google Scholar 

  10. Blajchman MA (2002) Immunomodulation and blood transfusion. Am J Ther 9:389–395

    Article  PubMed  Google Scholar 

  11. Blumberg N, Heal JM (1996) Immunomodulation by blood transfusion: an evolving scientific and clinical challenge. Am J Med 101:299–308

    Article  PubMed  CAS  Google Scholar 

  12. Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ (2002) Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 74:1180–1186

    Article  PubMed  Google Scholar 

  13. Rao SV, Jollis JG, Harrington RA, Granger CB, Newby LK, Armstrong PW, Moliterno DJ, Lindblad L, Pieper K, Topol EJ, Stamler JS, Califf RM (2004) Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 292:1555–1562

    Article  PubMed  CAS  Google Scholar 

  14. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, Starr NJ, Blackstone EH (2006) Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 34:1608–1616

    Article  PubMed  Google Scholar 

  15. Ellenberger C, Schweizer A, Diaper J, Kalangos A, Murith N, Katchatourian G, Panos A, Licker M (2006) Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery. Intensive Care Med 32:1808–1816

    Article  PubMed  Google Scholar 

  16. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D, ABC (Anemia and Blood Transfusion in Critical Care) Investigators (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507

    Google Scholar 

  17. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM (2001) Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 345:1230–1236

    Article  PubMed  CAS  Google Scholar 

  18. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical Care Trials Group. N Engl J Med 340:409–417

    Article  PubMed  CAS  Google Scholar 

  19. Spiess BD, Ley C, Body SC, Siegel LC, Stover EP, Maddi R, D′Ambra M, Jain U, Liu F, Herskowitz A, Mangano DT, Levin J (1998) Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting. The institutions of the Multicenter Study of Perioperative Ischemia (McSPI) Research Group. J Thorac Cardiovasc Surg 116:460–467

    Google Scholar 

  20. Bracey AW, Radovancevic R, Riggs SA, Houston S, Cozart H, Vaughn WK, Radovancevic B, McAllister HA Jr, Cooley DA (1999) Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion 39:1070–1077

    Article  PubMed  CAS  Google Scholar 

  21. Hébert PC, Fergusson DA (2004) Do transfusions get to the heart of the matter? JAMA 292:1610–1612

    Article  PubMed  Google Scholar 

  22. The Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP, Hessel EA II, Haan CK, Royston BD, Bridges CR, Higgins RS, Despotis G, Brown JR, Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Spiess BD, Shore-Lesserson L, Stafford-Smith M, Mazer CD, Bennett-Guerrero E, Hill SE, Body S (2007) Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline. Ann Thorac Surg 83:S27–S86

    Google Scholar 

  23. Reyes A, Vega G, Blancas R, Morato B, Moreno JL, Torrecilla C, Cereijo E (1997) Early vs. conventional extubation after cardiac surgery with cardiopulmonary bypass. Chest 112:193–201

    Article  PubMed  CAS  Google Scholar 

  24. Bojar RM (2005) Blackwell Publishing, USA, pp 358–371

  25. Bernstein AD, Parsonnet V (2000) Bedside estimation of risk as an aid for decision-making in cardiac surgery. Ann Thorac Surg 69:823–828

    Article  PubMed  CAS  Google Scholar 

  26. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  27. Curran-Everett D, Benos DJ (2004) Guidelines for reporting statistics in journals published by the American Physiological Society. Physiol Genomics 18:249–251

    Article  PubMed  Google Scholar 

  28. Sterne JAC, Smith GD (2001) Sifting the evidence – what’s wrong with significance tests? Br Med J 322:226–261

    Article  CAS  Google Scholar 

  29. Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, Djaiani G, Ivanov J, Karski J, David TE (2005) Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 129:391–400

    Article  PubMed  CAS  Google Scholar 

  30. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A (2003) Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg 125:1438–1450

    Article  PubMed  Google Scholar 

  31. Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, Moehnle P, Mangano DT, Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation (2007) Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 116:471–479

    Google Scholar 

  32. Spence RK, Alexander JB, DelRossi AJ, Cernaianu AD, Cilley J Jr, Pello MJ, Atabek U, Camishion RC, Vertrees RA (1992) Transfusion guidelines for cardiovascular surgery: lessons learned from operations in Jehovah’s witnesses. J Vasc Surg 16:825–829

    Article  PubMed  CAS  Google Scholar 

  33. Cohen E, Neustein SM, Silvay G (1993) Profound anemia following cardiac surgery. J Cardiothorac Vasc Anesth 7:721–723

    Article  PubMed  CAS  Google Scholar 

  34. Murphy GJ, Reeves BA, Rogers CA, Rizvi SI, Culliford L, Angelini GD (2007) Increased mortality, postoperative morbidity and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 116:2544–2552

    Article  PubMed  Google Scholar 

  35. Leal-Noval SR, Jara-López I, García-Garmendia JL, Marín-Niebla A, Herruzo-Avilés A, Camacho-Laraña P, Loscertales J (2003) Influence of erythrocyte concentrate storage time on postsurgical morbidity in cardiac surgery patients. Anesthesiology 98:815–822

    Article  PubMed  Google Scholar 

  36. Tinmouth A, Fergusson D, Yee IC, Hébert PC (2006) Clinical consequences of red cell storage in the critically ill. Transfusion 46:2014–2027

    Article  PubMed  Google Scholar 

  37. Reynolds LD, Ahearn GS, Angelo M, Zhang J, Cobb F, Stamler JS (2007) S-nitrosohemoglobin deficiency: a mechanism for loss of physiological activity in banked blood. Proc Natl Acad Sci USA 104:17058–17062

    Article  PubMed  CAS  Google Scholar 

  38. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, Blackstone EH (2008) Duration of red-cell storage and complications after cardiac surgery. N Engl Med 358:1229–1239

    Article  CAS  Google Scholar 

  39. Scott BH, Seifert FC, Grimson R (2008) Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth 11:15–19

    Article  PubMed  Google Scholar 

  40. Vamvakas EC, Carven JH (2000) RBC transfusion and postoperative length of stay in the hospital or the intensive care unit among patients undergoing coronary artery bypass graft surgery: the effects of confounding factors. Transfusion 40:832–839

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We acknowledge the contribution of J. Valero PhD and the nursing team at our ICU to this project.

Conflict of interest statement

No potential conflict of interest relevant to this article has been reported.

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Authors and Affiliations

  1. Department of Intensive Care, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Eva Oliver, Maria L. Carrio, David Rodríguez-Castro, Elisabet Farrero, Herminia Torrado & Josep L. Ventura

  2. Faculty of Medicine, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Casimiro Javierre

  3. Department of Cardiac Surgery, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Eduard Castells

Authors
  1. Eva Oliver
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Correspondence to Eva Oliver.

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Oliver, E., Carrio, M.L., Rodríguez-Castro, D. et al. Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery. Intensive Care Med 35, 1548–1555 (2009). https://doi.org/10.1007/s00134-009-1526-0

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  • DOI: https://doi.org/10.1007/s00134-009-1526-0

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