Intraoperative transfusion and an increased preoperative C-reactive protein level are associated with higher mortality after off-pump coronary artery bypass grafting

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Abstract

Objective: The effects of transfusion on clinical outcomes after cardiac surgery remain inconclusive. We hypothesized that the risk of postoperative cumulative long-term, all-cause mortality after transfusion in patients undergoing cardiac surgery would differ by individual inflammatory status reflected by C-reactive protein level; thus, we performed a retrospective study. Methods: All patients who underwent isolated off-pump coronary artery bypass grafting between October 2004 and October 2015 were retrospectively included. Patients were divided into 4 categories according to whether the preoperative C-reactive protein level was greater than or less than 1 mg/dL and whether red cells were transfused intraoperatively. The 4 categories were as follows: low C-reactive protein without transfusion; low C-reactive protein with transfusion; high C-reactive protein without transfusion; and high C-reactive protein with transfusion. A multivariable Cox regression was then performed. Sensitivity analysis in subgroup (<3 units of red cells transfused) was also performed. Results: A total of 1636 patients were analyzed. Of the 4 categories, patients in the high C-reactive protein with transfusion group were at significantly higher risk of mortality than the low C-reactive protein without transfusion (hazard ratio, 1.86; 95% confidence interval, 1.24-2.79) or with transfusion group (hazard ratio, 1.47; 95% confidence interval, 1.13-1.93). A sensitivity analysis of patients who received only 1 or 2 units of red cells showed similar results. Conclusions: Intraoperative red blood cell transfusion in patients with increased C-reactive protein level was significantly related to the risk of mortality after off-pump coronary artery bypass grafting.

Original languageEnglish
Pages (from-to)558-565
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume159
Issue number2
DOIs
StatePublished - Feb 2020

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Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
C-Reactive Protein
Mortality
Thoracic Surgery
Confidence Intervals
Erythrocyte Transfusion
Retrospective Studies

Keywords

  • C-reactive protein
  • coronary artery bypass grafting
  • inflammation
  • mortality
  • transfusion

Cite this

@article{1899154ef90547f2946b9e9358f0fd57,
title = "Intraoperative transfusion and an increased preoperative C-reactive protein level are associated with higher mortality after off-pump coronary artery bypass grafting",
abstract = "Objective: The effects of transfusion on clinical outcomes after cardiac surgery remain inconclusive. We hypothesized that the risk of postoperative cumulative long-term, all-cause mortality after transfusion in patients undergoing cardiac surgery would differ by individual inflammatory status reflected by C-reactive protein level; thus, we performed a retrospective study. Methods: All patients who underwent isolated off-pump coronary artery bypass grafting between October 2004 and October 2015 were retrospectively included. Patients were divided into 4 categories according to whether the preoperative C-reactive protein level was greater than or less than 1 mg/dL and whether red cells were transfused intraoperatively. The 4 categories were as follows: low C-reactive protein without transfusion; low C-reactive protein with transfusion; high C-reactive protein without transfusion; and high C-reactive protein with transfusion. A multivariable Cox regression was then performed. Sensitivity analysis in subgroup (<3 units of red cells transfused) was also performed. Results: A total of 1636 patients were analyzed. Of the 4 categories, patients in the high C-reactive protein with transfusion group were at significantly higher risk of mortality than the low C-reactive protein without transfusion (hazard ratio, 1.86; 95{\%} confidence interval, 1.24-2.79) or with transfusion group (hazard ratio, 1.47; 95{\%} confidence interval, 1.13-1.93). A sensitivity analysis of patients who received only 1 or 2 units of red cells showed similar results. Conclusions: Intraoperative red blood cell transfusion in patients with increased C-reactive protein level was significantly related to the risk of mortality after off-pump coronary artery bypass grafting.",
keywords = "C-reactive protein, coronary artery bypass grafting, inflammation, mortality, transfusion",
author = "Karam Nam and Yunseok Jeon and Kim, {Tae Kyong} and Kim, {Ki Bong} and Hwang, {Ho Young} and Cho, {Youn Joung}",
year = "2020",
month = "2",
doi = "10.1016/j.jtcvs.2019.01.078",
language = "English",
volume = "159",
pages = "558--565",
journal = "Journal of Thoracic and Cardiovascular Surgery",
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number = "2",

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TY - JOUR

T1 - Intraoperative transfusion and an increased preoperative C-reactive protein level are associated with higher mortality after off-pump coronary artery bypass grafting

AU - Nam, Karam

AU - Jeon, Yunseok

AU - Kim, Tae Kyong

AU - Kim, Ki Bong

AU - Hwang, Ho Young

AU - Cho, Youn Joung

PY - 2020/2

Y1 - 2020/2

N2 - Objective: The effects of transfusion on clinical outcomes after cardiac surgery remain inconclusive. We hypothesized that the risk of postoperative cumulative long-term, all-cause mortality after transfusion in patients undergoing cardiac surgery would differ by individual inflammatory status reflected by C-reactive protein level; thus, we performed a retrospective study. Methods: All patients who underwent isolated off-pump coronary artery bypass grafting between October 2004 and October 2015 were retrospectively included. Patients were divided into 4 categories according to whether the preoperative C-reactive protein level was greater than or less than 1 mg/dL and whether red cells were transfused intraoperatively. The 4 categories were as follows: low C-reactive protein without transfusion; low C-reactive protein with transfusion; high C-reactive protein without transfusion; and high C-reactive protein with transfusion. A multivariable Cox regression was then performed. Sensitivity analysis in subgroup (<3 units of red cells transfused) was also performed. Results: A total of 1636 patients were analyzed. Of the 4 categories, patients in the high C-reactive protein with transfusion group were at significantly higher risk of mortality than the low C-reactive protein without transfusion (hazard ratio, 1.86; 95% confidence interval, 1.24-2.79) or with transfusion group (hazard ratio, 1.47; 95% confidence interval, 1.13-1.93). A sensitivity analysis of patients who received only 1 or 2 units of red cells showed similar results. Conclusions: Intraoperative red blood cell transfusion in patients with increased C-reactive protein level was significantly related to the risk of mortality after off-pump coronary artery bypass grafting.

AB - Objective: The effects of transfusion on clinical outcomes after cardiac surgery remain inconclusive. We hypothesized that the risk of postoperative cumulative long-term, all-cause mortality after transfusion in patients undergoing cardiac surgery would differ by individual inflammatory status reflected by C-reactive protein level; thus, we performed a retrospective study. Methods: All patients who underwent isolated off-pump coronary artery bypass grafting between October 2004 and October 2015 were retrospectively included. Patients were divided into 4 categories according to whether the preoperative C-reactive protein level was greater than or less than 1 mg/dL and whether red cells were transfused intraoperatively. The 4 categories were as follows: low C-reactive protein without transfusion; low C-reactive protein with transfusion; high C-reactive protein without transfusion; and high C-reactive protein with transfusion. A multivariable Cox regression was then performed. Sensitivity analysis in subgroup (<3 units of red cells transfused) was also performed. Results: A total of 1636 patients were analyzed. Of the 4 categories, patients in the high C-reactive protein with transfusion group were at significantly higher risk of mortality than the low C-reactive protein without transfusion (hazard ratio, 1.86; 95% confidence interval, 1.24-2.79) or with transfusion group (hazard ratio, 1.47; 95% confidence interval, 1.13-1.93). A sensitivity analysis of patients who received only 1 or 2 units of red cells showed similar results. Conclusions: Intraoperative red blood cell transfusion in patients with increased C-reactive protein level was significantly related to the risk of mortality after off-pump coronary artery bypass grafting.

KW - C-reactive protein

KW - coronary artery bypass grafting

KW - inflammation

KW - mortality

KW - transfusion

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DO - 10.1016/j.jtcvs.2019.01.078

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