医学
低温沉淀
倾向得分匹配
围手术期
四分位间距
心脏外科
危险系数
输血
外科
优势比
内科学
置信区间
纤维蛋白原
作者
Jake V. Hinton,Zhongyue Xing,Calvin Fletcher,Luke A. Perry,Alexandra Karamesinis,Jenny Shi,Dhruvesh M. Ramson,Jahan C. Penny‐Dimri,Zhengyang Liu,Jenni Williams‐Spence,Tim G. Coulson,Julian A. Smith,Reny Segal,Rinaldo Bellomo
标识
DOI:10.1016/j.athoracsur.2023.02.054
摘要
Background Cryoprecipitate is often transfused in patients undergoing cardiac surgery. However, its safety and effectiveness remain uncertain. Methods This study was a propensity score–matched analysis of data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. The study included adults undergoing cardiac surgery between 2005 and 2018 across 38 sites. The association between perioperative cryoprecipitate transfusion and clinical outcomes was estimated, with a primary outcome of operative mortality. Results Of 119,132 eligible patients, 11,239 (9.43%) patients received cryoprecipitate. The median cumulative dose was 8 U (interquartile range, 5-10 U). After propensity score matching, we matched 9055 cryoprecipitate recipients to 9055 control subjects. Postoperative cryoprecipitate transfusion was associated with reduced operative mortality (odds ratio [OR], 0.82; 99% CI, 0.69-0.97; P = .002) and long-term mortality (hazard ratio, 0.92; 99% CI, 0.87-0.97; P = .0042). It was also associated with a reduction in acute kidney injury (OR, 0.85; 99% CI, 0.73-0.98; P = .0037) and all-cause infection (OR, 0.77; 99% CI, 0.67-0.88; P < .0001). These findings were observed despite increased rates of return to the operating room (OR, 1.36; 99% CI, 1.22-1.51; P < .0001) and cumulative 4-hour postoperative chest tube output (adjusted mean difference in mL, 97.69; 99% CI, 81.65;113.74; P < .0001). Conclusions In a large, multicenter cohort study and after propensity score matching, perioperative transfusion of cryoprecipitate was associated with reduced operative and long-term mortality.
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