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Iron deficiency is associated with higher mortality in patients undergoing cardiac surgery: a prospective study
Julian Rössler1, Felix Schoenrath2, Burkhardt Seifert3
1Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Insights
Iron deficiency in cardiac surgery patients significantly increases mortality and adverse events. Screening for iron deficiency is crucial for better patient outcomes and blood management.
Area of Science:
- Cardiology
- Hematology
- Surgical Outcomes
Background:
- Iron deficiency is common in cardiac surgery patients but its clinical impact is not well understood.
- This study investigates the association between preoperative iron deficiency and outcomes after cardiac surgery.
Purpose of the Study:
- To determine the impact of preoperative iron deficiency, with or without anemia, on clinical outcomes in patients undergoing cardiac surgery.
- To assess the relationship between iron deficiency and mortality, serious adverse events, major adverse cardiac and cerebrovascular events, blood transfusion needs, and hospital stay.
Main Methods:
- A prospective observational study of 730 patients undergoing elective cardiac surgery.
- Patients were categorized into four groups based on iron status (ferritin <100 μg L⁻¹) and anemia.
- Outcomes including mortality, SAEs, MACCEs, transfusion, and hospital stay were assessed over a 90-day follow-up, with statistical adjustments for confounders.
Main Results:
- Preoperative iron deficiency was associated with a significant increase in 90-day mortality, rising from 2% to 5% in non-anemic patients and 4% to 14% in anemic patients.
- Logistic regression showed an odds ratio of 3.5 (95% CI: 1.5-8.4; P=0.004) for mortality, persisting in multivariate models.
- Iron deficiency also correlated with higher rates of SAEs, MACCEs, blood transfusion, and longer hospital stays.
Conclusions:
- Preoperative iron deficiency is an independent predictor of increased mortality, SAEs, and prolonged hospital stay following cardiac surgery.
- These findings emphasize the importance of preoperative iron deficiency screening within patient blood management programs.
- Iron deficiency represents a significant research area in cardiac surgery.
Background:
Iron deficiency is frequent in patients undergoing cardiac surgery. The relevance of iron deficiency, however, is ill defined. Therefore, our study aimed to investigate the impact of iron deficiency (ferritin <100 μg L-1) with or without concomitant anaemia on clinical outcome after cardiac surgery.
Methods:
In this prospective observational study, 730 patients undergoing elective cardiac surgery were assigned into four groups according to their iron status and anaemia. Mortality, serious adverse events (SAEs), major cardiac and cerebrovascular events (MACCEs), allogenic blood transfusion requirements, and length of hospital stay were assessed during a 90-day follow-up period. The effect of iron deficiency on these outcomes was first calculated in models adjusting for anaemia only, followed by two multivariate models adjusting for anaemia and either the EuroSCORE II or any possible confounders.
Results:
The presence of iron deficiency (ferritin <100 μg L-1) was associated with an increase in 90-day mortality from 2% to 5% in patients without anaemia, and from 4% to 14% in patients with anaemia. Logistic regression resulted in an odds ratio of 3.5 (95% confidence interval: 1.5-8.4); P=0.004. The effect persisted in both multivariate models. Moreover, iron deficiency was associated with an increased incidence of SAEs, MACCEs, transfusion, and prolonged hospital stay.
Conclusions:
Preoperative iron deficiency (ferritin <100 μg L-1) was independently associated with increased mortality, more SAEs, and prolonged hospital stay after cardiac surgery. These findings underline the importance of preoperative iron deficiency screening in the context of a comprehensive patient blood management programme, and highlight its importance as a research topic in cardiac surgery.
Clinical Trial Registration:
NCT02031289.
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