Karkouti Keyvan, O'Farrell Rachel, Yau Terrence M, Beattie W Scott
University Health Network, Toronto General Hospital, Department of Anesthesia, EN 3-402, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
Can J Anaesth. 2006 Aug;53(8):781-94. doi: 10.1007/BF03022795.
In cardiac surgery with cardiopulmonary bypass (CPB), excessive blood loss requiring the transfusion of multiple red blood cell (RBC) units is a common complication that is associated with significant morbidity and mortality. The objective of this study was to develop a prediction rule for massive blood transfusion (MBT) that could be used to optimize the management of, and research on, at-risk patients.
Data were collected prospectively over the period from 2000 to 2005, on patients who underwent surgery with CPB at one hospital. Patients who received > or = five units of RBC within one day of surgery were classified as MBT. Logistic regression was used to appropriately select and weigh perioperative variables in the prediction rule, which was developed on the initial 60% of the sample and validated on the remaining 40%.
Of the 10,667 patients included, 925 (8.7%) had MBT. The clinical prediction rule included 12 variables (listed in order of predictive value: CPB duration, preoperative hemoglobin concentration, body surface area, nadir CPB hematocrit, previous sternotomy, preoperative shock, preoperative platelet count, urgency of surgery, age, surgeon, deep hypothermic circulatory arrest, and type of procedure) and was highly discriminative (c-index = 0.88). In the validation set, those classified as low-, moderate-, and high-risk by a simple risk score derived from the prediction rule had a 5%, 27%, and 58% chance of MBT, respectively.
A clinical prediction rule was developed that accurately identified patients at low-risk or high-risk for MBT. Studies are needed to determine the external generalizability and clinical utility of the prediction rule.
在体外循环心脏手术中，大量失血需要输注多个红细胞（RBC）单位是一种常见并发症，与显著的发病率和死亡率相关。本研究的目的是制定一种大量输血（MBT）预测规则，可用于优化对高危患者的管理和研究。
前瞻性收集了2000年至2005年期间在一家医院接受体外循环手术患者的数据。在手术一天内接受≥5个RBC单位的患者被归类为MBT。逻辑回归用于在预测规则中适当选择和权衡围手术期变量，该规则基于样本的初始60%制定，并在其余40%上进行验证。
纳入的10667例患者中，925例（8.7%）发生MBT。临床预测规则包括12个变量（按预测价值排序：体外循环持续时间、术前血红蛋白浓度、体表面积、体外循环最低血细胞比容、既往胸骨切开术、术前休克、术前血小板计数、手术紧急程度、年龄、外科医生、深度低温循环停搏和手术类型），具有高度的辨别力（c指数 = 0.88）。在验证集中，根据预测规则得出的简单风险评分分为低、中、高风险的患者发生MBT的概率分别为5%、27%和58%。
制定了一种临床预测规则，可准确识别MBT低风险或高风险患者。需要进行研究以确定该预测规则的外部普遍性和临床实用性。
