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Observational Study
. 2015 Apr;17(4):357-61.
doi: 10.1111/hpb.12376. Epub 2014 Dec 16.

Assessment of the external validity of a predictive score for blood transfusion in liver surgery

Sylvie Janny  1 , Mathilde Eurin, Safi Dokmak, Amélie Toussaint, Olivier Farges, Catherine Paugam-Burtz
Affiliations
Observational Study

Assessment of the external validity of a predictive score for blood transfusion in liver surgery

Sylvie Janny et al. HPB (Oxford). 2015 Apr.

Abstract

Background: Perioperative bleeding is a predictor of morbidity following liver resection. The transfusion-related score (TRS), which is derived from five variables (cirrhosis, preoperative haemoglobin level, tumour size, vena cava exposure and associated extraliver surgical procedure), has been proposed to predict the likelihood of transfusion in liver resection.

Objective: The purpose of this observational study was to evaluate the external validity of the TRS.

Methods: In a retrospective, monocentre, observational cohort study of patients undergoing elective liver resection surgery, data for transfused and non-transfused patients were compared by univariate analysis. The TRS was calculated for each patient. The frequency of transfusion was calculated for each score level. The accuracy of the TRS was evaluated using the area under the receiver operator characteristic curve (AUC).

Results: A total of 205 patients submitted to liver resection were included. Of these, 48 (23.4%) patients received a blood transfusion. There was no significant difference between transfused and non-transfused patients in age, American Society of Anesthesiologists (ASA) score or cirrhosis. The AUC for the TRS was 0.68 (95% confidence interval 0.59-0.77). Among TRS items, only vena cava exposure and associated surgical procedures were significantly associated with risk for transfusion.

Conclusions: In the present population, the TRS appeared to serve as a weak predictor of perioperative transfusion. This study confirms that the external validity of the transfusion predictive score should be subject to further investigation before it can be implemented in clinical use.

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Figures

Figure 1
Figure 1
Frequencies of transfusion of red blood cell units in patients undergoing liver resection (n = 205)
Figure 2
Figure 2
Transfusion rates according to transfusion-related scores in the Pulitanò et al. population (n = 320) and the present population (n = 163) of patients undergoing liver resection
Figure 3
Figure 3
Receiver operating curve (ROC) for the performance of the original transfusion-related score in predicting transfusion in the present population (n = 205) of patients undergoing liver resection
See this image and copyright information in PMC

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