肾移植手术患者血红蛋白的相对降低与预后：一项回顾性队列研究。
Relative decrease in hemoglobin and outcomes in patients undergoing kidney transplantation surgery: A retrospective cohort study.
作者信息
MacIsaac Sarah, Ramanakumar Agnihotram V, Saw Chee, Naessens Veronique, Saberi Nasim, Cantarovich Marcelo, Baran Dana, Paraskevas Steven, Tchervenkov Jean, Chaudhury Prosanto, Sandal Shaifali
机构信息
Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
出版信息
Am J Surg. 2021 Oct;222(4):825-831. doi: 10.1016/j.amjsurg.2021.03.002. Epub 2021 Mar 5.
BACKGROUND
Recent surgical literature suggests that a relative decrease in hemoglobin (ΔHb) is predictive of adverse outcomes regardless of the absolute level. We aimed to examine the association between perioperative ΔHb and kidney transplantation (KT) outcomes.
METHODS
This was a retrospective cohort study of transplant recipients, where ΔHb = [Hb0- Hb1Hb0]x 100 (Hb = hemoglobin pre-KT and Hb = lowest hemoglobin 24-h post-KT). The main outcome of interest was immediate graft function (IGF).
RESULTS
Of the 899 eligible patients, 38% experienced IGF, and ΔHb was associated with 36% lower odds of IGF. Also, ΔHb was associated with higher all-cause graft failure and longer length of stay but not death-censored graft failure or mortality. ΔHb ≥30% was the threshold beyond which the odds of IGF were significantly lower even if Hb was ≥7 g/dL.
CONCLUSION
ΔHb is associated with inferior outcomes independent of Hb whether it can be used to guide transfusion practices should be explored.
背景
近期外科文献表明，血红蛋白的相对降低（ΔHb）可预测不良结局，而与绝对水平无关。我们旨在研究围手术期ΔHb与肾移植（KT）结局之间的关联。
方法
这是一项对移植受者的回顾性队列研究，其中ΔHb = [（术前血红蛋白 - 术后24小时最低血红蛋白）/术前血红蛋白]×100（Hb = 肾移植术前血红蛋白，Hb = 肾移植术后24小时最低血红蛋白）。主要关注的结局是即刻移植肾功能（IGF）。
结果
在899例符合条件的患者中，38%经历了即刻移植肾功能恢复，且ΔHb与即刻移植肾功能恢复的几率降低36%相关。此外，ΔHb与全因移植失败率较高和住院时间较长相关，但与死亡删失的移植失败或死亡率无关。ΔHb≥30%是一个阈值，超过该阈值，即使血红蛋白≥7 g/dL，即刻移植肾功能恢复的几率也会显著降低。
结论
ΔHb与不良结局相关，与血红蛋白水平无关，是否可用于指导输血实践有待探索。
Zotero 插件