Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

Lopes, Camila Takao; Brunori, Evelise Helena Fadini Reis; Cavalcante, Agueda Maria Ruiz Zimmer; Moorhead, Sue Ann; Lopes, Juliana de Lima; Barros, Alba Lucia Bottura Leite de

doi:10.1590/S0080-623420150000600006

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 49 (6) • Dec 2015 • https://doi.org/10.1590/S0080-623420150000600006 copy

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study ^* * Extracted from the thesis "Incidência de sangramento excessivo e preditores no pós-operatório imediato de cirurgia cardíaca", Escola Paulista de Enfermagem, Universidade Federal de São Paulo, 2015.

Fatores preditores de transfusão de concentrado de hemácias após cirurgia cardíaca: um estudo coorte prospectivo

Factores predictivos de transfusión de concentrado de hematíes después de cirugía cardiaca: un estudio cohorte prospectivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery.

METHOD

A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression.

RESULTS

The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 ³/mm³, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg.

CONCLUSION

Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

Descriptors
Thoracic Surgery; Hemorrhage; Blood Transfusion; Erythrocyte Transfusion; Cardiovascular Nursing

Variable	RBC transfusion (n=20)	No RBC transfusion (n=303)	p-value
Age (years)	67.35±9.08	59.75±13.23	0.012
Gender
Male	12 (60.0)	194 (64.0)	0.811
Female	8 (40.0)	109 (36)
Weight (Kg)	65.65±11.64	73.94±14.83	0.014
Height (m)	1.60±0.10	1.65±0.09	0.025
Body mass index (Kg/m ²⁾	25.81±4.98	27.07±4.66	0.151
Preoperative platelet count (x10³/mm³⁾	177.95±78.63	232.86±744.20	<0.001
Preoperative platelet count <150x10³/mm ³	7 (35.0)	22 (7.3)	0.001
Preoperative hemoglobin (g/dL)	12.97±2.04	13.71±1.79	0.047
Preoperative hematocrit (%)	39.79±6.20	41.44±5.18	0.109
International normalized prothrombin time ratio	1.14±0.20	1.11±0.15	0.745
Activated partial thromboplastin time ratio	1.07±3.90	1.09±0.28	0.798
Preoperative fibrinogen levels (mg/dL)	298.22±64.16	329.19±87.35	0.158
Left ventricle ejection fraction (%)	54.61±15.97	57.39±11.53	0.894
Use of aspirin	15 (88.2)	190 (84.1)	1.000
Use of warfarin	1 (5.9)	15 (6.6)	1.000
Use of clopidogrel	0	34 (14.9)	0.140
Cardiogenic shock	0	6 (2.0)	1.000
Kidney failure	1 (5.0)	13 (4.3)	0.603
Heart failure	12 (63.2)	182 (63.2)	1.000
New York Heart Association functional class			0.355
II	5 (27.8)	115 (41.2)
III	6 (33.3)	50 (17.9)
IV	0	8 (2.9)
Hypertension	17 (85)	234 (77.2)	0.582
Type I diabetes	0	5 (1.7)	1.000
Chronic obstructive pulmonary disease	0	20 (6.6)	0.623
Peripheral vascular disease	2 (10)	17 (5.6)	0.332

Variables	RBC transfusion (n=20)	No RBC transfusion (n=303)	p-value
Type of surgery
Coronary artery bypass grafting	10 (50.0)	148 (48.9)	0.983
Valve	8 (40.0)	111 (36.6)
Combined	2 (10.0)	25 (8.3)
Aorta	0	13 (4.0)
Heart transplantation	0	5 (1.7)
Mixoma excision	0	1 (0.3)
Surgical urgency
Elective	20 (100.0)	299 (99.3)	1.000
Emergency	0	2 (0.7)	1.000
Type of valve
Biological	7 (77.7)	84 (74.3)	1.000
Mechanical	2 (22.2)	29 (25.3)	1.000
Use of cardiopulmonary bypass time	20 (100.0)	301 (99.3)
Cardiopulmonary bypass time (min)	105.60±41.47	100.97±43.77	0.439
Aorta clamp time (min)	73.55±33.56	71.00±35.40	0.582
Initial activated clotting time (min)	162.25±29.28	158.67±35.33	0.407
Final activated clotting time (min)	151.65±23.70	154.66±32.50	0.802
Sternal wires (n)	5.74±1.05	5.89±0.88	0.298
Bypasses (n)	2.42±0.90	2.66±0.82	0.356
Chest tubes (n)	1.95±0.69	1.81±0.69	0.354
Heparin (mL)	6.25±2.45	6.30±1.31	0.197
Protamine (mL)	23.10±5.64	25.81±5.39	0.015
Duration of anesthesia (min)	369.75±66.14	338.78±75.20	0.032
Fluid volume (mL)	2700.00±909.02	2894.78±831.10	0.462
Use of ε-aminocaproic acid	9 (45.0)	146 (48.2)	0.821
Use of cell saver	0	8 (2.6)	1.000
Use of autologous transfusion	1 (5.0)	63 (20.8)	0.142
Surgical team			0.951
A	2 (10.0)	38 (12.5)
B	4 (20.0)	56 (18.5)
C	4 (20.0)	37 (12.2)
D	0	9 (3.0)
E	4 (20.0)	40 (13.2)
F	0	3 (1.0)
G	2 (10.0)	19 (6.3)
H	1 (5.0)	22 (7.3)
I	1 (5.0)	33 (10.9)
J	0	5 (1.7)
K	0	19 (6.3)
L	2 (10.0)	21 (6.9)
M	0	1 (0.3)
Intraoperative transfusion
Red blood cell	8 (40)	63 (20.8)	0.054
Fresh frozen plasma	3 (15)	32 (10.6)	0.465
Cryoprecipitate	1 (5)	20 (6.6)	1.000
Platelet	3 (15)	16 (5.3)	0.104

Variables	RBC transfusion (n=20)	No RBC transfusion (n=303)	p-value
Lowest temperature (°C)	34.59±1.09	35.14±0.73	0.025
Highest MAP (mmHg)	98.45±18.85	100.52±14.18	0.765
Highest heart rate (bpm)	116.70±20.22	104.49±17.94	0.012
Highest respiratory rate (rpm)	22.05±4.71	21.55±3.15	0.853
IV volume (mL)	1457.89±882.12	1279.06±686.12	0.415
Highest PEEP (cmH₂O)	6.35±3.01	5.37±1.06	0.016
Metabolic acidosis	11 (55.0)	144 (47.5)	0.645

Variables	p-value	Odds ratio	95% confidence interval
Age (years)	0.091	1.04	0.99-1.10
Height (m)	0.613	0.14	0.00-309.29
Weight (Kg)	0.046	0.94	0.89-1.00
Preoperative hemoglobin (g/dL)	0.370	0.86	0.61-1.20
Preoperative platelet count (x10³/mm³⁾	0.304	1.00	0.99-1.00
Preoperative fibrinogen levels (mg/dL)	0.402	1.00	0.99-1.00
Duration of anesthesia (min)	0.291	1.00	1.00-1.01
Lowest postoperative temperature (°C)	0.829	0.92	0.45-1.90
Highest postoperative heart rate (bpm)	0.073	1.03	1.00-1.06
Highest postoperative positive end expiratory pressure (cmH ₂O)	0.064	1.36	0.98-1.87

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Camila Takao Lopes. Escola Paulista de Enfermagem, Universidade Federal de São Paulo. Rua Napoleão de Barros 754, 2º andar, CEP 04024-002 - São Paulo, SP, Brazil.camilatakao@hotmail.com

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Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study * * Extracted from the thesis "Incidência de sangramento excessivo e preditores no pós-operatório imediato de cirurgia cardíaca", Escola Paulista de Enfermagem, Universidade Federal de São Paulo, 2015.

Fatores preditores de transfusão de concentrado de hemácias após cirurgia cardíaca: um estudo coorte prospectivo

Factores predictivos de transfusión de concentrado de hematíes después de cirugía cardiaca: un estudio cohorte prospectivo

Abstract

OBJECTIVE

METHOD

RESULTS

CONCLUSION

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study ^* * Extracted from the thesis "Incidência de sangramento excessivo e preditores no pós-operatório imediato de cirurgia cardíaca", Escola Paulista de Enfermagem, Universidade Federal de São Paulo, 2015.