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Risk-Prediction Model for Transfusion of Erythrocyte Concentrate During Extracorporeal Circulation in Coronary
Patrícia Pinheiro Paiva1,2, Filipe Miguel Leite3, Pedro E Antunes3
1Department of Clinical Pharmacology, Hospital and University Centre of Coimbra, Coimbra, Portugal.
Insights
This study identifies key preoperative risk factors for blood transfusion during heart surgery. The developed model accurately predicts the need for erythrocyte concentrate transfusions in coronary artery bypass grafting patients.
Area of Science:
- Cardiology
- Transfusion Medicine
- Surgical Risk Assessment
Background:
- Coronary artery bypass grafting (CABG) often requires blood transfusions.
- Predicting the need for erythrocyte concentrate (EC) transfusion during extracorporeal circulation (ECC) is crucial for patient management.
- Identifying preoperative risk factors can optimize transfusion strategies.
Purpose of the Study:
- To identify preoperative risk factors for EC transfusion during ECC in CABG patients.
- To develop and validate a predictive model for EC transfusion necessity.
- To improve clinical practice and patient outcomes through accurate risk assessment.
Main Methods:
- Retrospective observational study of 530 isolated on-pump CABG patients.
- Logistic regression and bootstrap analysis for risk model development and validation.
- Assessment of model discrimination (AUC) and calibration (Hosmer-Lemeshow test).
Main Results:
- 17.2% of patients required EC transfusion during ECC.
- Significant predictors included age, glomerular filtration rate, body surface area, peripheral vascular disease, cerebrovascular disease, and hematocrit.
- The risk model demonstrated excellent discriminatory power (AUC: 0.963) and accurate calibration.
Conclusions:
- A validated risk-prediction model for EC transfusion during ECC in CABG patients was developed.
- The model accurately predicts transfusion needs and can guide clinical practice.
- Implementation of this model can optimize surgical quality and patient care.
Introduction:
Our objective was to identify preoperative risk factors and to develop and validate a risk-prediction model for the need for blood (erythrocyte concentrate [EC]) transfusion during extracorporeal circulation (ECC) in patients undergoing coronary artery bypass grafting (CABG).
Methods:
This is a retrospective observational study including 530 consecutive patients who underwent isolated on-pump CABG at our Centre over a full two-year period. The risk model was developed and validated by logistic regression and bootstrap analysis. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (H-L) test, respectively.
Results:
EC transfusion during ECC was required in 91 patients (17.2%). Of these, the majority were transfused with one (54.9%) or two (41.8%) EC units. The final model covariates (reported as odds ratios; 95% confidence interval) were age (1.07; 1.02-1.13), glomerular filtration rate (0.98; 0.96-1.00), body surface area (0.95; 0.92-0.98), peripheral vascular disease (3.03; 1.01-9.05), cerebrovascular disease (4.58; 1.29-16.18), and hematocrit (0.55; 0.48-0.63). The risk model developed has an excellent discriminatory power (AUC: 0,963). The results of the H-L test showed that the model predicts accurately both on average and across the ranges of deciles of risk.
Conclusions:
A risk-prediction model for EC transfusion during ECC was developed, which performed adequately in terms of discrimination, calibration, and stability over a wide spectrum of risk. It can be used as an instrument to provide accurate information about the need for EC transfusion during ECC, and as a valuable adjunct for local improvement of clinical practice. Key Findings: Risk factors with the greatest prediction for EC transfusion. Take-Home Message: The implementation of this model would be an important step in optimizing and improving the quality of surgery.
