Prohaska W, Zittermann A, Inoue K, Tenderich G, Lüth J-U, Köster-Eiserfunke W, Körfer R, Kleesiek K
Institut für Laboratoriums- and Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Goethestr. 11, 32545 Bad Oeynhausen, Germany.
Eur J Med Res. 2008 Nov 24;13(11):525-30.
Standard haemostasis screening tests are performed to reveal unknown congenital or acquired disturbances of plasma and/or platelet haemostasis. Since their diagnostic efficacy is often low, routinely performed haemostasis testing has been questioned. We investigated whether preoperatively assessed haemostasis testing can be used to predict the requirement of blood products.
We retrospectively assessed haemostasis parameters including platelet function testing by PFA 100 as well as the numbers of red blood cell (RBC) concentrates, fresh frozen plasmas (FFPs), and platelet concentrates (PCs) that were given peri-operatively and during the first two postoperative days in 2,831 cardiac surgery patients. Logistic regression analyses were used to select those parameters, which could predict blood product requirement.
Of our study cohort, 56.5% needed RBCs, 15% FFPs, and 5% PCs. The need for RBCs was associated with significantly altered pre-operative values of most haemostasis parameters. However, by the use of logistic regression analysis fibrinogen was the only haemostasis parameter that was independently associated with the use of RBCs (odds ratio 1.56; 95% CI: 1.27-1.91; P <0.001). The predictive value of other parameters such as age, body weight, haemoglobin, and haematocrit was however much higher in comparison to fibrinogen (odds ratios: 1.92-3.50; P <0.001). It was not possible to develop a score based on haemostasis parameters to accurately identify patients at risk for RBC use. Moreover, we were unable to estimate the need for FFPs and PCs using preoperative haemostasis testing.
Our data demonstrate that preoperatively performed haemostasis testing is not predictive in estimating the need for blood products in cardiac surgery patients.
进行标准止血筛查试验以揭示血浆和/或血小板止血方面未知的先天性或后天性紊乱。由于其诊断效能往往较低，常规进行的止血检测受到了质疑。我们研究了术前评估的止血检测是否可用于预测血液制品的需求。
我们回顾性评估了2831例心脏手术患者的止血参数，包括通过血小板功能分析仪（PFA 100）进行的血小板功能检测，以及围手术期和术后前两天给予的红细胞浓缩液、新鲜冰冻血浆和血小板浓缩液的数量。采用逻辑回归分析来选择那些能够预测血液制品需求的参数。
在我们的研究队列中，56.5%的患者需要红细胞，15%需要新鲜冰冻血浆，5%需要血小板浓缩液。红细胞需求与大多数止血参数的术前值显著改变相关。然而，通过逻辑回归分析，纤维蛋白原是唯一与红细胞使用独立相关的止血参数（比值比1.56；95%置信区间：1.27 - 1.91；P < 0.001）。然而，与纤维蛋白原相比，年龄、体重、血红蛋白和血细胞比容等其他参数的预测价值要高得多（比值比：1.92 - 3.50；P < 0.001）。不可能基于止血参数制定一个评分来准确识别有红细胞使用风险的患者。此外，我们无法通过术前止血检测来估计新鲜冰冻血浆和血小板浓缩液的需求。
我们的数据表明，术前进行的止血检测在估计心脏手术患者对血液制品的需求方面没有预测价值。
