| Nadir hematocrit during cardiopulmonary bypass: End-organ dysfunction and mortality. | |
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MedLine Citation:
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PMID: 22507841 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: To discover the effects of the lowest hematocrit during cardiopulmonary bypass on end-organ function and mortality in patients who did not receive red blood cell transfusion and to identify the predictors of the nadir hematocrit. METHODS: From November 1, 2004, to October 1, 2009, 7957 patients underwent cardiac surgery supported by cardiopulmonary bypass and were not transfused. The relationship between the nadir hematocrit and morbidity, markers of end-organ function, and survival was studied using generalized propensity score analysis. The factors associated with the nadir hematocrit were identified by linear regression analysis. RESULTS: The median nadir hematocrit was 30% (25th to 75th percentile, 27%-33%). A lower nadir hematocrit was associated with greater maximum intraoperative lactic acid (intrasubject correlation, -0.44). After risk adjustment, the nadir hematocrit was associated with worse renal function (lower estimated glomerular filtration rate; P = .012), more myocardial injury (greater troponin level; P = .004), longer postoperative ventilator support (P < .001), longer hospital stay (P < .001), and greater mortality (P = .042). Female gender, older age, lower body mass index, higher New York Heart Association class, and combined valve procedure and coronary artery bypass were associated with a lower nadir hematocrit; however, the strongest correlate was the preoperative hematocrit (correlation coefficient, 0.74). CONCLUSIONS: Although red blood cell transfusion has associated morbidity risk, there must be a tradeoff between the adverse effects of a low hematocrit during cardiac surgery and those of transfusion. The strong association of the nadir hematocrit with the preoperative hematocrit suggests the need for investigation and optimization before elective cardiac surgery. |
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Authors:
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Gabriel Loor; Liang Li; Joseph F Sabik; Jeevanantham Rajeswaran; Eugene H Blackstone; Colleen G Koch |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-4-14 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: - ISSN: 1097-685X ISO Abbreviation: - Publication Date: 2012 Apr |
Date Detail:
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Created Date: 2012-4-17 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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