Milo Engoren1, Thomas A Schwann2, Robert H Habib3, Sean N Neill4, Jennifer L Vance4, Donald S Likosky5. 1. Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; Department of Anesthesiology, Mercy St. Vincent Medical Center, Toledo, Ohio. Electronic address: engorenm@med.umich.edu. 2. Department of Cardiothoracic Surgery, University of Toledo, Toledo, Ohio. 3. Department of Internal Medicine and Outcomes Unit, American University of Beirut, Beirut, Lebanon. 4. Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan. 5. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Both anemia and transfusions (Tx) are associated with mortality after cardiac operations. However, the relative contributions of anemia and Tx and their interaction on late mortality have not been determined. METHODS: 922 patients who underwent isolated coronary artery bypass grafting (CABG) were retrospectively studied. Anemia (A+) was defined as hemoglobin<12 g/dL for men and <11 g/dL for women. Patients who received (Tx+) and did not receive (Tx-) transfusions were compared; patient characteristics were controlled for by the use of Cox analysis and then by matching Tx+ to Tx- patients based on identical hemoglobin levels at admission and by propensity matching. RESULTS: 5.3% of Tx- patients died, compared with 11% of Tx+ patients (p=0.001). The interaction of anemia and Tx was associated with a greater hazard of dying. In particular, A+Tx+ (anemic, received transfusion) patients had a threefold hazard of death (2.918, 95% confidence interval=1.512-5.633, p=0.001) compared with A-Tx- (nonanemic, no transfusion) patients. A+Tx+ patients had twice the hazard of dying as did A+Tx- (anemic, no transfusion) (hazard ratio=2.087, 95% confidence interval=1.004-4.336, p=0.049). In populations matched by preoperative hemoglobin levels or by propensity scores, similar results were seen: a significant interaction between anemia and transfusion of red blood cells. A+Tx+ patients fared significantly worse than did the other three groups. Although there was no difference in mortality between A- patients who did or did not receive transfusions, A+T+ patients had triple the risk as A+T- patients, whereas A+Tx- patients had a similar risk of late mortality as A-Tx- patients. CONCLUSIONS: The anemia-transfusion interaction was associated with an increased hazard of late mortality.
BACKGROUND: Both anemia and transfusions (Tx) are associated with mortality after cardiac operations. However, the relative contributions of anemia and Tx and their interaction on late mortality have not been determined. METHODS: 922 patients who underwent isolated coronary artery bypass grafting (CABG) were retrospectively studied. Anemia (A+) was defined as hemoglobin<12 g/dL for men and <11 g/dL for women. Patients who received (Tx+) and did not receive (Tx-) transfusions were compared; patient characteristics were controlled for by the use of Cox analysis and then by matching Tx+ to Tx- patients based on identical hemoglobin levels at admission and by propensity matching. RESULTS: 5.3% of Tx- patients died, compared with 11% of Tx+ patients (p=0.001). The interaction of anemia and Tx was associated with a greater hazard of dying. In particular, A+Tx+ (anemic, received transfusion) patients had a threefold hazard of death (2.918, 95% confidence interval=1.512-5.633, p=0.001) compared with A-Tx- (nonanemic, no transfusion) patients. A+Tx+ patients had twice the hazard of dying as did A+Tx- (anemic, no transfusion) (hazard ratio=2.087, 95% confidence interval=1.004-4.336, p=0.049). In populations matched by preoperative hemoglobin levels or by propensity scores, similar results were seen: a significant interaction between anemia and transfusion of red blood cells. A+Tx+ patients fared significantly worse than did the other three groups. Although there was no difference in mortality between A- patients who did or did not receive transfusions, A+T+ patients had triple the risk as A+T- patients, whereas A+Tx- patients had a similar risk of late mortality as A-Tx- patients. CONCLUSIONS: The anemia-transfusion interaction was associated with an increased hazard of late mortality.
Authors: Donald S Likosky; Robert A Baker; Timothy A Dickinson; Daniel J FitzGerald; M Filip De Somer; Robert C Groom; David FitzGerald; Kenneth G Shann; Michael Poullis; Bruce D Spiess; Karim Jabr; Mark T Lucas; James D Ferguson; Shahna L Bronson Journal: J Extra Corpor Technol Date: 2015-06
Authors: Timothy A Dickinson; Xiaoting Wu; David L Sturmer; Joshua Goldberg; David C Fitzgerald; Gaetano Paone; Donald S Likosky Journal: J Extra Corpor Technol Date: 2019-12
Authors: Joshua B Goldberg; Kenneth G Shann; David Fitzgerald; John Fuller; Theron A Paugh; Timothy A Dickinson; Gaetano Paone; Richard L Prager; Donald S Likosky Journal: J Extra Corpor Technol Date: 2016-12
Authors: Edward Litton; Stuart Baker; Wendy N Erber; Shannon Farmer; Janet Ferrier; Craig French; Joel Gummer; David Hawkins; Alisa Higgins; Axel Hofmann; Bart De Keulenaer; Julie McMorrow; John K Olynyk; Toby Richards; Simon Towler; Robert Trengove; Steve Webb Journal: Intensive Care Med Date: 2016-09-30 Impact factor: 17.440
Authors: Islam Mohammad Shehata; Tiffany D Odell; Amir Elhassan; Maxim Spektor; Ivan Urits; Omar Viswanath; George M Jeha; Elyse M Cornett; Alan D Kaye Journal: Cardiol Ther Date: 2020-12-23
Authors: Pierre Tibi; R Scott McClure; Jiapeng Huang; Robert A Baker; David Fitzgerald; C David Mazer; Marc Stone; Danny Chu; Alfred H Stammers; Tim Dickinson; Linda Shore-Lesserson; Victor Ferraris; Scott Firestone; Kalie Kissoon; Susan Moffatt-Bruce Journal: J Extra Corpor Technol Date: 2021-06
Authors: Carlos E Arias-Morales; Nicoleta Stoicea; Alicia A Gonzalez-Zacarias; Diana Slawski; Sujatha P Bhandary; Theodosios Saranteas; Eva Kaminiotis; Thomas J Papadimos Journal: F1000Res Date: 2017-02-20