Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting

Colleen Koch, Liang Li, Andra I. Duncan, Tomislav Mihaljevic, Delos M. Cosgrove, Floyd D. Loop, Norman J. Starr, Eugene H. Blackstone

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting. DESIGN: The study design was an observational cohort study. SETTING: This investigation took place at a large tertiary care referral center. PATIENTS: A total of 11,963 patients who underwent isolated coronary artery bypass from January 1, 1995, through July 1, 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6%) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event: mortality (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.67-1.87; p <.0001), renal failure (OR, 2.06; 95% CI, 1.87-2.27; p <.0001), prolonged ventilatory support (OR, 1.79; 95% CI, 1.72-1.86; p <.0001), serious infection (OR, 1.76; 95% CI, 1.68-1.84; p <.0001), cardiac complications (OR, 1.55; 95% CI, 1.47-1.63; p <.0001), and neurologic events (OR, 1.37; 95% CI, 1.30-1.44; p <.0001). CONCLUSIONS: Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.

Original languageEnglish (US)
Pages (from-to)1608-1616
Number of pages9
JournalCritical Care Medicine
Volume34
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Blood Component Transfusion
Cellular Structures
Coronary Artery Bypass
Erythrocytes
Odds Ratio
Confidence Intervals
Morbidity
Erythrocyte Transfusion
Mortality
Tertiary Care Centers
Hospital Mortality
Nervous System
Observational Studies
Renal Insufficiency
Cohort Studies
Logistic Models
Infection

Keywords

  • Blood cells
  • Cardiopulmonary bypass
  • Cardiovascular disease
  • Complications
  • Hemoglobin
  • Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. / Koch, Colleen; Li, Liang; Duncan, Andra I.; Mihaljevic, Tomislav; Cosgrove, Delos M.; Loop, Floyd D.; Starr, Norman J.; Blackstone, Eugene H.

In: Critical Care Medicine, Vol. 34, No. 6, 06.2006, p. 1608-1616.

Research output: Contribution to journalArticle

Koch, Colleen ; Li, Liang ; Duncan, Andra I. ; Mihaljevic, Tomislav ; Cosgrove, Delos M. ; Loop, Floyd D. ; Starr, Norman J. ; Blackstone, Eugene H. / Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. In: Critical Care Medicine. 2006 ; Vol. 34, No. 6. pp. 1608-1616.
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abstract = "OBJECTIVE: Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting. DESIGN: The study design was an observational cohort study. SETTING: This investigation took place at a large tertiary care referral center. PATIENTS: A total of 11,963 patients who underwent isolated coronary artery bypass from January 1, 1995, through July 1, 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6{\%}) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event: mortality (odds ratio [OR], 1.77; 95{\%} confidence interval [CI], 1.67-1.87; p <.0001), renal failure (OR, 2.06; 95{\%} CI, 1.87-2.27; p <.0001), prolonged ventilatory support (OR, 1.79; 95{\%} CI, 1.72-1.86; p <.0001), serious infection (OR, 1.76; 95{\%} CI, 1.68-1.84; p <.0001), cardiac complications (OR, 1.55; 95{\%} CI, 1.47-1.63; p <.0001), and neurologic events (OR, 1.37; 95{\%} CI, 1.30-1.44; p <.0001). CONCLUSIONS: Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.",
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T1 - Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting

AU - Koch, Colleen

AU - Li, Liang

AU - Duncan, Andra I.

AU - Mihaljevic, Tomislav

AU - Cosgrove, Delos M.

AU - Loop, Floyd D.

AU - Starr, Norman J.

AU - Blackstone, Eugene H.

PY - 2006/6

Y1 - 2006/6

N2 - OBJECTIVE: Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting. DESIGN: The study design was an observational cohort study. SETTING: This investigation took place at a large tertiary care referral center. PATIENTS: A total of 11,963 patients who underwent isolated coronary artery bypass from January 1, 1995, through July 1, 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6%) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event: mortality (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.67-1.87; p <.0001), renal failure (OR, 2.06; 95% CI, 1.87-2.27; p <.0001), prolonged ventilatory support (OR, 1.79; 95% CI, 1.72-1.86; p <.0001), serious infection (OR, 1.76; 95% CI, 1.68-1.84; p <.0001), cardiac complications (OR, 1.55; 95% CI, 1.47-1.63; p <.0001), and neurologic events (OR, 1.37; 95% CI, 1.30-1.44; p <.0001). CONCLUSIONS: Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.

AB - OBJECTIVE: Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting. DESIGN: The study design was an observational cohort study. SETTING: This investigation took place at a large tertiary care referral center. PATIENTS: A total of 11,963 patients who underwent isolated coronary artery bypass from January 1, 1995, through July 1, 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6%) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event: mortality (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.67-1.87; p <.0001), renal failure (OR, 2.06; 95% CI, 1.87-2.27; p <.0001), prolonged ventilatory support (OR, 1.79; 95% CI, 1.72-1.86; p <.0001), serious infection (OR, 1.76; 95% CI, 1.68-1.84; p <.0001), cardiac complications (OR, 1.55; 95% CI, 1.47-1.63; p <.0001), and neurologic events (OR, 1.37; 95% CI, 1.30-1.44; p <.0001). CONCLUSIONS: Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.

KW - Blood cells

KW - Cardiopulmonary bypass

KW - Cardiovascular disease

KW - Complications

KW - Hemoglobin

KW - Mortality

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