Risk associated with preoperative anemia in cardiac surgery - A multicenter cohort study
Risk associated with preoperative anemia in cardiac surgery - A multicenter cohort study
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DOI：
10.1161/circulationaha.107.718353
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发表时间：
2008-01-29
期刊：
影响因子：
37.8
通讯作者：
Beattie, W. Scott
中科院分区：
文献类型：
--
作者：
Karkouti, Keyvan;Wijeysundera, Duminda N.;Beattie, W. Scott
背景-术前贫血是围手术期红细胞输注的重要危险因素，与术后发病率和死亡率有关。然而，术前贫血是否也是心脏手术后不良结局的独立危险因素还没有完全阐明。方法和结果-在这项多中心队列研究中，收集了2004年在7家学术医院接受心脏手术的3500名患者的数据。获得了术前贫血的患病率，定义为血红蛋白12.5g/dL，以及它与住院死亡、中风或急性肾损伤的综合结局的未经调整和调整的关系。术前贫血的总体患病率为26%，参与医院的患病率从22%到30%不等。排除严重的术前贫血(血红蛋白9.5g/dL)或术前肾功能衰竭和接受急诊手术的患者后，7.5%的患者观察到了综合结果(3286例中的247例)。贫血患者与非贫血患者的综合结果的未调整优势比为3.6(95%可信区间为2.7至4.7)。通过多变量Logistic回归和倾向-分数匹配控制重要混杂因素(包括合并症、机构、手术因素和输血)得到的风险调整优势比分别为2.0(95%可信区间，1.4~2.8)和1.8(95%可信区间，1.2~2.7)。结论：术前贫血与心脏手术后的不良结局独立相关。未来的研究应该确定，旨在治疗术前贫血的疗法是否会改善心脏手术患者的结局。
Background - Preoperative anemia is an important risk factor for perioperative red blood cell transfusions, which are associated with postoperative morbidity and mortality. Whether preoperative anemia also is an independent risk factor for adverse outcomes after cardiac surgery, however, has not been fully elucidated.Methods and Results - In this multicenter cohort study, data were collected on 3500 consecutive patients who underwent cardiac surgery during 2004 at 7 academic hospitals. The prevalence of preoperative anemia, defined as hemoglobin < 12.5 g/dL, and its unadjusted and adjusted relationships with the composite outcome of in-hospital death, stroke, or acute kidney injury were obtained. The overall prevalence of preoperative anemia was 26%, with values ranging from 22% to 30% at the participating hospitals. After the exclusion of patients who had severe preoperative anemia (hemoglobin < 9.5 g/dL) or preoperative kidney failure and those who underwent emergency surgery, the composite outcome was observed in 7.5% of patients (247 of 3286). The unadjusted odds ratio for the composite outcome in anemic versus nonanemic patients was 3.6 (95% confidence interval, 2.7 to 4.7). The risk-adjusted odds ratios, obtained by multivariable logistic regression and propensity-score matching to control for important confounders (including comorbidities, institution, surgical factors, and blood transfusion), were 2.0 (95% confidence interval, 1.4 to 2.8) and 1.8 (95% confidence interval, 1.2 to 2.7), respectively.Conclusions - Preoperative anemia is independently associated with adverse outcomes after cardiac surgery. Future studies should determine whether therapies aimed at treating preoperative anemia would improve the outcomes of patients undergoing cardiac surgery.