Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective

Arias-Morales, Carlos E; Stoicea, Nicoleta; Gonzalez-Zacarias, Alicia A.; Slawski, Diana E.; Bhandary, Sujatha; Saranteas, Theodosios; Kaminiotis, Eva; Papadimos, Thomas J.

doi:10.12688/f1000research.10085.1

Cited by 33 publications

(16 citation statements)

References 40 publications

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“…2017)[ 12 ] with a proven reduction in both costs and complications. There have however been contrarian thoughts from the specialty of CS highlighting the role of anemia in aggravating renal injury[ 13 ] and transfusion in improving more global outcome,[ 14 ] our study could not demonstrate any association between blood component use and AKI-CS.…”

Section: Discussioncontrasting

confidence: 67%

Predictors of acute kidney injury in patients undergoing adult cardiac surgery

Gangadharan¹,

Sundaram²,

Vasudevan³

et al. 2018

Ann Card Anaesth

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Background:Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS.Aims and Objectives:The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication.Methods:Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described.Results:Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population.Conclusions:The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.

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Section: Discussioncontrasting

confidence: 67%

Predictors of acute kidney injury in patients undergoing adult cardiac surgery

Gangadharan¹,

Sundaram²,

Vasudevan³

et al. 2018

Ann Card Anaesth

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“…The burden of disease in Indigenous Australians is more than twice that of non‐Indigenous Australians and chronic disease, such as cardiovascular and chronic kidney disease, play a major role in this disparity . Patients who have had cardiac surgery and chronic kidney disease have increased blood transfusion requirements that may adversely affect their clinical outcomes, especially since their blood group antigens are poorly characterized. Our study has shown the value of massively parallel sequence data toward elucidating complete blood group antigen profiles for the Indigenous Australian population for comparison with other population groups.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive blood group antigen profile predictions for Western Desert Indigenous Australians from whole exome sequence data

et al. 2018

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BACKGROUND The distribution of RBC antigens, which define blood group types, differs among populations. In contrast to many world populations, blood group profiles for Indigenous Australians have not been well studied. As it is now possible to predict comprehensive blood group antigen profiles from genomic data sets, we aimed to apply this for Indigenous Australians and to provide a comparison to other major world populations. STUDY DESIGN AND METHODS Whole exome sequence data for 72 Western Desert Indigenous Australians was provided by the Telethon Kids Institute. Variants (against hg19) were annotated using computer software (ANNOVAR, Qiagen Bioinformatics) and filtered to include only variants in genes for 36 blood group systems, and the transcription factors KLF1 and GATA1. The RHCE*C allele and RHD zygosity were identified by copy number variant analysis of sequence alignments. The impact of missense variants was investigated in silico using a meta‐predictor of disease‐causing variants (Meta‐SNP). RESULTS For 21 blood group systems the predicted blood group antigen frequencies were comparable to those for other major world populations. For 13 systems, interesting points of contrast were identified. Furthermore, we identified 12 novel variants, one novel D allele, and four rare variants with potential clinical significance. CONCLUSION This is the first systematic assessment of genomic data to elucidate blood group antigen profiles for Indigenous Australians who are linguistically and culturally diverse. Our study paves the way to understanding the geographic distribution of blood group variants in different Indigenous groups and the associated RBC phenotypes. This in turn is expected to guide transfusion practice for Indigenous individuals.

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“…Excessive blood loss during cardiac surgery is associated with an increased incidence of blood transfusion, reoperation, prolonged hospital stay and death. [1][2][3][4] Excessive blood loss may be due to surgical factors alone, but may be compounded by impaired coagulation if plasma coagulation factors fall below critical levels. 4 This is more likely if cardiopulmonary bypass (CPB) is used, due to the associated haemodilution.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of viscoelastic point-of-care identification of hypofibrinogenaemia in cardiac surgical patients: A systematic review

Gibbs

Weightman

2020

Anaesth Intensive Care

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Hypofibrinogenaemia during cardiac surgery may increase blood loss and bleeding complications. Viscoelastic point-of-care tests provide more rapid diagnosis than laboratory measurement, allowing earlier treatment. However, their diagnostic test accuracy for hypofibrinogenaemia has never been reviewed systematically. We aimed to systematically review their diagnostic test accuracy for the identification of hypofibrinogenaemia during cardiac surgery. Two reviewers assessed relevant articles from seven electronic databases, extracted data from eligible articles and assessed quality. The primary outcomes were sensitivity, specificity and positive and negative predictive values. A total of 576 articles were screened and 81 full texts were assessed, most of which were clinical agreement or outcome studies. Only 10 diagnostic test accuracy studies were identified and only nine were eligible (ROTEM delta 7; TEG5000 1; TEG6S 1, n = 1820 patients) (ROTEM, TEM International GmbH, Munich, Germany; TEG, Haemonetics, Braintree, MA, USA). None had a low risk of bias. Four ROTEM studies with a fibrinogen threshold less than 1.5–1.6 g/l and FIBTEM threshold A10 less than 7.5–8 mm had point estimates for sensitivity of 0.61–0.88; specificity 0.54–0.94; positive predictive value 0.42–0.70; and negative predictive value 0.74–0.98 (i.e. false positive rate 30%–58%; false negative rate 2%–26%). Two ROTEM studies with higher thresholds for both fibrinogen (<2 g/l) and FIBTEM A10 (<9.5 mm) had similar false positive rates (25%–46%), as did the two TEG studies (15%–48%). This review demonstrates that there have been few diagnostic test accuracy studies of viscoelastic point-of-care identification of hypofibrinogenaemia in cardiac surgical patients. The studies performed so far report false positive rates of up to 58%, but low false negative rates. Further diagnostic test accuracy studies of viscoelastic point-of-care identification of hypofibrinogenaemia are required to guide their better use during cardiac surgery.

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Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective

Cited by 33 publications

References 40 publications

Predictors of acute kidney injury in patients undergoing adult cardiac surgery

Predictors of acute kidney injury in patients undergoing adult cardiac surgery

Comprehensive blood group antigen profile predictions for Western Desert Indigenous Australians from whole exome sequence data

Diagnostic accuracy of viscoelastic point-of-care identification of hypofibrinogenaemia in cardiac surgical patients: A systematic review

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