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Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft.

Santos AA, Sousa AG, Piotto RF, Pedroso JC - Rev Bras Cir Cardiovasc (2013 Oct-Dec)

Bottom Line: The increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation.The greater the amount of allogeneic blood transfused the greater the risk of mortality.The current transfusion practice needs to be reevaluated.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Transfusions of one or more packed red blood cells is a widely strategy used in cardiac surgery, even after several evidences of increased morbidity and mortality. The world's blood shortage is also already evident.

Objective: To assess whether the risk of mortality is dose-dependent on the number of packed red blood cells transfused after coronary artery bypass graft.

Methods: Between June 2009 and July 2010, were analyzed 3010 patients: transfused and non-transfused. Transfused patients were divided into six groups according to the number of packed red blood cells received: one, two, three, four, five, six or more units, then we assess the mortality risk in each group after a year of coronary artery bypass graft. To calculate the odds ratio was used the multivariate logistic regression model.

Results: The increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation. The odds ratio values increase with the increased number of packed red blood cells transfused. The death's gross odds ratio was 1.42 (P=0.165), 1.94 (P=0.005), 4.17; 4.22, 8.70, 33.33 (P<0.001) and the adjusted death's odds ratio was 1.22 (P=0.43), 1.52 (P=0.08); 2.85; 2.86; 4.91 and 17.61 (P<0.001), as they received one, two, three, four, five, six or more packed red blood cells, respectively.

Conclusion: The mortality risk is directly proportional to the number of packed red blood cells transfused in coronary artery bypass graft. The greater the amount of allogeneic blood transfused the greater the risk of mortality. The current transfusion practice needs to be reevaluated.

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Frequency histogram of the packed red blood cells units transfused
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f01: Frequency histogram of the packed red blood cells units transfused

Mentions: A total of 4,936 units of packed red blood cells were transfused in 1888 patients duringtheir hospital stay, which corresponds to 62.8% of the patients who underwent CABGsurgery. Of those, 1,155 patients (61.2%) were male patients and 733 (38.8%) femalepatients. The age ranged from 31 to 89 years with a standard deviation of 9.37 years anda median of 64.01 years. The demographics data and characteristics of the transfusedpatients assessed in the study are described in Table1. The average number of packed red blood cells units transfused per patientwas 2.6 ± 2.4 (1-25) units. The transfusions of one, two and three units of PRBCswere the most common frequencies of the blood units transfused: 33.1%; 32.3% and 14.4%,respectively. They account for approximately 80% of the transfused patients who received3 or less units of allogeneic blood (Figure 1).The group receiving no RBCT showed a total of 1,116 patients.


Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft.

Santos AA, Sousa AG, Piotto RF, Pedroso JC - Rev Bras Cir Cardiovasc (2013 Oct-Dec)

Frequency histogram of the packed red blood cells units transfused
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4389431&req=5

f01: Frequency histogram of the packed red blood cells units transfused
Mentions: A total of 4,936 units of packed red blood cells were transfused in 1888 patients duringtheir hospital stay, which corresponds to 62.8% of the patients who underwent CABGsurgery. Of those, 1,155 patients (61.2%) were male patients and 733 (38.8%) femalepatients. The age ranged from 31 to 89 years with a standard deviation of 9.37 years anda median of 64.01 years. The demographics data and characteristics of the transfusedpatients assessed in the study are described in Table1. The average number of packed red blood cells units transfused per patientwas 2.6 ± 2.4 (1-25) units. The transfusions of one, two and three units of PRBCswere the most common frequencies of the blood units transfused: 33.1%; 32.3% and 14.4%,respectively. They account for approximately 80% of the transfused patients who received3 or less units of allogeneic blood (Figure 1).The group receiving no RBCT showed a total of 1,116 patients.

Bottom Line: The increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation.The greater the amount of allogeneic blood transfused the greater the risk of mortality.The current transfusion practice needs to be reevaluated.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Transfusions of one or more packed red blood cells is a widely strategy used in cardiac surgery, even after several evidences of increased morbidity and mortality. The world's blood shortage is also already evident.

Objective: To assess whether the risk of mortality is dose-dependent on the number of packed red blood cells transfused after coronary artery bypass graft.

Methods: Between June 2009 and July 2010, were analyzed 3010 patients: transfused and non-transfused. Transfused patients were divided into six groups according to the number of packed red blood cells received: one, two, three, four, five, six or more units, then we assess the mortality risk in each group after a year of coronary artery bypass graft. To calculate the odds ratio was used the multivariate logistic regression model.

Results: The increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation. The odds ratio values increase with the increased number of packed red blood cells transfused. The death's gross odds ratio was 1.42 (P=0.165), 1.94 (P=0.005), 4.17; 4.22, 8.70, 33.33 (P<0.001) and the adjusted death's odds ratio was 1.22 (P=0.43), 1.52 (P=0.08); 2.85; 2.86; 4.91 and 17.61 (P<0.001), as they received one, two, three, four, five, six or more packed red blood cells, respectively.

Conclusion: The mortality risk is directly proportional to the number of packed red blood cells transfused in coronary artery bypass graft. The greater the amount of allogeneic blood transfused the greater the risk of mortality. The current transfusion practice needs to be reevaluated.

Show MeSH
Related in: MedlinePlus