Geng Wenyan, Ye Lulu, Yu Xuegao, Yang Qinfeng, Wang Linlin, Li Xiaodan, Xiao Qing, Wang Jian
Department of Blood Transfusion, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University, No. 63 Duobao Road, Liwan District, Guangzhou, Guangdong, 510150, China.
Guangxi University of Chinese Medicine, Nanning, Guangxi, 530022, China.
BMC Rheumatol. 2025 Aug 13;9(1):101. doi: 10.1186/s41927-025-00554-3.
Allogeneic blood transfusion is a common therapeutic intervention for patients with rheumatoid arthritis (RA) undergoing lower extremity joint replacement (LEJR). Despite the potential for adverse outcomes associated with blood transfusion, the risks related to this procedure in RA patients remain underexplored, particularly within the framework of a large-scale national dataset.
This study analyzed data from the National Inpatient Sample (NIS) database from 2010 to 2019, identifying 66,674 patients diagnosed with RA who underwent LEJR. These cases were subsequently divided into two groups based on whether they received blood transfusion. Univariate and multivariate logistic regression analyses were conducted on patient demographics, the prevalence of comorbidities, hospital-level characteristics, total financial charges, insurance coverage, and in-hospital mortality rates.
The cumulative blood transfusion rate among RA patients undergoing LEJR was 10.9%, showing a declining trend over the study period (from 23.79% in 2010 to 3.67% in 2019). Several factors were associated with an increased likelihood of receiving blood transfusion, including advanced age (≥ 65 years), female sex, deficiency anemia, chronic blood loss anemia, weight loss, coagulopathy, fluid and electrolyte imbalances, neurological disorders, pulmonary circulatory disturbances, congestive heart failure, chronic kidney disease, and uncomplicated diabetes. Moreover, patients who received blood transfusion demonstrated a higher risk of specific complications, including wound infection, acute myocardial infarction, pneumonia, acute kidney injury, urinary tract infection, postoperative delirium, deep vein thrombosis, lower limb nerve injury, sepsis, and respiratory failure.
Thorough preoperative assessment is essential for identifying RA patients who were more likely to receive blood transfusion and be subjected to adverse outcomes. Proactive interventions during the perioperative period, coupled with the implementation of a comprehensive blood management strategy, can optimize blood transfusion in RA patients after LEJR.
同种异体输血是类风湿关节炎（RA）患者接受下肢关节置换术（LEJR）时常见的治疗干预措施。尽管输血存在潜在不良后果，但在RA患者中与该手术相关的风险仍未得到充分研究，尤其是在大规模国家数据集的框架内。
本研究分析了2010年至2019年国家住院样本（NIS）数据库中的数据，确定了66674例诊断为RA并接受LEJR的患者。随后根据是否接受输血将这些病例分为两组。对患者人口统计学、合并症患病率、医院层面特征、总费用、保险覆盖范围和住院死亡率进行单因素和多因素逻辑回归分析。
接受LEJR的RA患者累计输血率为10.9%，在研究期间呈下降趋势（从2010年的23.79%降至2019年的3.67%）。几个因素与输血可能性增加相关，包括高龄（≥65岁）、女性、缺铁性贫血、慢性失血性贫血、体重减轻、凝血障碍、液体和电解质失衡、神经疾病、肺循环障碍、充血性心力衰竭、慢性肾病和无并发症的糖尿病。此外，接受输血的患者出现特定并发症的风险更高，包括伤口感染、急性心肌梗死、肺炎、急性肾损伤、尿路感染、术后谵妄、深静脉血栓形成、下肢神经损伤、败血症和呼吸衰竭。
全面的术前评估对于识别更可能接受输血并遭受不良后果的RA患者至关重要。围手术期的积极干预，加上实施全面的血液管理策略，可以优化RA患者LEJR术后的输血情况。
