Kulier Alexander, Levin Jack, Moser Rita, Rumpold-Seitlinger Gudrun, Tudor Iulia Cristina, Snyder-Ramos Stephanie A, Moehnle Patrick, Mangano Dennis T
Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austri.
Circulation. 2007 Jul 31;116(5):471-9. doi: 10.1161/CIRCULATIONAHA.106.653501. Epub 2007 Jul 9.
The risk of preoperative anemia in patients undergoing heart surgery has not been described precisely. Specifically, the impact of low hemoglobin per se or combined with other risk factors on postoperative outcome is unknown. Thus, we determined the effects of low preoperative hemoglobin and comorbidities on postoperative adverse outcomes in patients with coronary artery bypass graft in a large comprehensive multicenter study.
The Multicenter Study of Perioperative Ischemia investigated 5065 patients with coronary artery bypass graft at 70 institutions worldwide, collecting approximately 7500 data points per patient. In 4804 patients who received no preoperative transfusions, we determined the association between lowest preoperative hemoglobin levels and in-hospital cardiac and noncardiac morbidity and mortality and the impact of concomitant risk factors, assessed by EuroSCORE, on this effect. In patients with EuroSCORE < 4 (n=2054), only noncardiac outcomes were increased, whereas patients with EuroSCORE > or = 4 (n=2750) showed an increased incidence of all postoperative events, starting at hemoglobin < 11 g/dL. Low preoperative hemoglobin was an independent predictor for noncardiac (renal > cerebral; P<0.001) outcomes, whereas the increase in cardiac events was due to other factors associated with preoperative anemia.
Anemic patients undergoing cardiac surgery have an increased risk of postoperative adverse events. Importantly, the extent of preexisting comorbidities substantially affects perioperative anemia tolerance. Therefore, preoperative risk assessment and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative hemoglobin and the extent of concomitant risk factors.
心脏手术患者术前贫血的风险尚未得到精确描述。具体而言，低血红蛋白本身或与其他风险因素相结合对术后结局的影响尚不清楚。因此，在一项大型综合性多中心研究中，我们确定了术前低血红蛋白和合并症对冠状动脉搭桥术患者术后不良结局的影响。
围手术期缺血多中心研究在全球70家机构调查了5065例冠状动脉搭桥术患者，每位患者收集约7500个数据点。在4804例未接受术前输血的患者中，我们确定了术前最低血红蛋白水平与住院期间心脏和非心脏发病率及死亡率之间的关联，以及欧洲心脏手术风险评估系统（EuroSCORE）评估的伴随风险因素对这种影响的作用。在EuroSCORE<4（n=2054）的患者中，仅非心脏结局增加，而EuroSCORE≥4（n=2750）的患者从血红蛋白<11 g/dL开始，所有术后事件的发生率均增加。术前低血红蛋白是心脏非相关（肾脏>大脑；P<0.001）结局的独立预测因素，而心脏事件的增加是由于与术前贫血相关的其他因素。
接受心脏手术的贫血患者术后发生不良事件的风险增加。重要的是，术前存在的合并症程度会显著影响围手术期对贫血的耐受性。因此，术前风险评估及后续治疗策略，如输血，应同时考虑术前血红蛋白的个体水平和伴随风险因素的程度。
