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Observational Study
. 2021 Jun 1;36(3):323-330.
doi: 10.21470/1678-9741-2020-0322.

Risk-Prediction Model for Transfusion of Erythrocyte Concentrate During Extracorporeal Circulation in Coronary Surgery

Patrícia Pinheiro Paiva  1   2 , Filipe Miguel Leite  3 , Pedro E Antunes  3 , Manuel J Antunes  4
Affiliations
Observational Study

Risk-Prediction Model for Transfusion of Erythrocyte Concentrate During Extracorporeal Circulation in Coronary Surgery

Patrícia Pinheiro Paiva et al. Braz J Cardiovasc Surg. .

Abstract

Introduction: Our objective was to identify preoperative risk factors and to develop and validate a risk-prediction model for the need for blood (erythrocyte concentrate [EC]) transfusion during extracorporeal circulation (ECC) in patients undergoing coronary artery bypass grafting (CABG).

Methods: This is a retrospective observational study including 530 consecutive patients who underwent isolated on-pump CABG at our Centre over a full two-year period. The risk model was developed and validated by logistic regression and bootstrap analysis. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (H-L) test, respectively.

Results: EC transfusion during ECC was required in 91 patients (17.2%). Of these, the majority were transfused with one (54.9%) or two (41.8%) EC units. The final model covariates (reported as odds ratios; 95% confidence interval) were age (1.07; 1.02-1.13), glomerular filtration rate (0.98; 0.96-1.00), body surface area (0.95; 0.92-0.98), peripheral vascular disease (3.03; 1.01-9.05), cerebrovascular disease (4.58; 1.29-16.18), and hematocrit (0.55; 0.48-0.63). The risk model developed has an excellent discriminatory power (AUC: 0,963). The results of the H-L test showed that the model predicts accurately both on average and across the ranges of deciles of risk.

Conclusions: A risk-prediction model for EC transfusion during ECC was developed, which performed adequately in terms of discrimination, calibration, and stability over a wide spectrum of risk. It can be used as an instrument to provide accurate information about the need for EC transfusion during ECC, and as a valuable adjunct for local improvement of clinical practice. Key Findings: Risk factors with the greatest prediction for EC transfusion. Take-Home Message: The implementation of this model would be an important step in optimizing and improving the quality of surgery.

Keywords: Blood Transfusion; Cardiopulmonary Bypass; Coronary Artery Bypass; Risk Factors; Risk-Prediction Model.

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Conflict of interest statement

No conflict of interest.

Figures

OR=odds ratio
OR=odds ratio
Key Question: What is the risk of the need for use of erythrocyte concentrate (EC) during cardiopulmonary bypass? Key Findings: Risk factors with the greatest prediction for EC transfusion. Take-Home Message: The implementation of this model would be an important step in optimizing and improving the quality of surgery.
Fig. 1
Fig. 1
Risk-prediction model. Observed vs. expected values of risk deciles.
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve of the risk-prediction model. The area under the model's ROC curve was 0.963 (95% confidence interval: 0.947-0.979).
See this image and copyright information in PMC

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