A A Klein1, T Collier2, J Yeates3, L F Miles4, S N Fletcher5, C Evans6, T Richards7. 1. Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK. 2. Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK. 3. Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia. 4. Department of Anaesthesia, Austin Health, Melbourne, Australia. 5. Departments of Anaesthesia and Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK. 6. Department of Anaesthesia, University Hospital Wales, Cardiff, Wales. 7. Department of Surgery, University College London, UK.
Abstract
BACKGROUND: A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking. METHODS: We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score. RESULTS: Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients. CONCLUSIONS: The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.
BACKGROUND: A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking. METHODS: We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score. RESULTS: Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients. CONCLUSIONS: The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.
Authors: Andreas Mitterecker; Axel Hofmann; Kevin M Trentino; Adam Lloyd; Michael F Leahy; Karin Schwarzbauer; Thomas Tschoellitsch; Carl Böck; Sepp Hochreiter; Jens Meier Journal: Transfusion Date: 2020-06-28 Impact factor: 3.157
Authors: Lachlan F Miles; Vanessa Pac Soo; Sabine Braat; Stephane Heritier; Kate L Burbury; David A Story Journal: Perioper Med (Lond) Date: 2022-02-08