scholarly journals Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center

2021 ◽  
Vol 11 (3) ◽  
pp. 108-113
Author(s):  
Jaeri Yoo ◽  
Byung Hee Kang
Keyword(s):  
Risk Factors ◽  
Glasgow Coma Scale ◽  
Blood Cell ◽  
Scale Score ◽  
Red Blood Cell ◽  
Glasgow Coma Scale Score ◽  
Red Blood Cell Transfusion ◽  
Major Bleed ◽  
Transfusion Volume ◽  
Emergent Laparotomy

Purpose: The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality.Methods: Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury.Results: There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), p = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), p < 0.001], major bleed from the liver [3.931 (1.203-12.850), p = 0.023], and blood lactate [1.173 (1.009-1.362), p = 0.037] were identified as risk factors for mortality.Conclusion: Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.

Rates, Risk Factors, and Complications of Red Blood Cell Transfusion in Metastatic Spinal Tumor Surgery: An Analysis of a Prospective Multicenter Surgical Database

2020 ◽  
Vol 139 ◽  
pp. e308-e315 ◽  
Author(s):  
Rafael De la Garza Ramos ◽  
Yaroslav Gelfand ◽  
Joshua A. Benton ◽  
Michael Longo ◽  
Murray Echt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Spinal Tumor ◽  
Red Blood Cell Transfusion ◽  
Tumor Surgery ◽  
Metastatic Spinal Tumor

Risk Factors for Red Blood Cell Transfusion After Coronary Artery Bypass Graft Surgery

2010 ◽  
Vol 24 (3) ◽  
pp. 413-417 ◽  
Author(s):  
Albert H.M. van Straten ◽  
Suzanne Kats ◽  
Margreet W.A. Bekker ◽  
Frank Verstappen ◽  
Joost F.J. ter Woorst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Blood Cell ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Red Blood Cell ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Red Blood Cell Transfusion ◽  
Artery Bypass Graft

scholarly journals RhD Immunization Despite Adequate Immunoprophylaxis: Role of Fc Gamma Receptor Gene Polymorphisms

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 759-759
Author(s):  
Tamara C Stegmann ◽  
Sietse Q Nagelkerke ◽  
Dian van Winkelhorst ◽  
Taco W Kuijpers ◽  
Gestur Vidarsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Genetic Variation ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Potential Risk ◽  
Caesarian Section ◽  
Red Blood Cell Transfusion ◽  
Control Group ◽  
Increased Risk ◽  
Potential Risk Factors

Abstract Introduction: One of the most effective immunological interventions in clinical medicine is the prevention of hemolytic disease of the newborn by prophylactic Rh immune globulin (Rh-Ig) therapy. The administration of ante- and postnatal Rh-Ig has reduced the risk of RhD immunization in the Netherlands from 17% to a mere 0.31%, yet its mechanism of action is still unknown. To gain more insight into the possible working mechanism of the Rh-Ig prophylaxis we analyzed potential risk factors and genotyped all known IgG-Fc receptor (protein FcγR, gene FCGR) variants known to date, on a cohort of Dutch women who failed Rh-Ig prophylaxis and developed anti-D antibodies. Adequate Rh-Ig immunoprophylaxis was defined as an antenatal and postnatal prophylaxis of 1,000 IU (200 µg) in both current and previous pregnancies, according to the Dutch guidelines. Material and Methods: Between 1999 and 2013 we identified 274 women who produced anti-D antibodies. Through a structured questionnaire we collected information about Rh-Ig prophylaxis and additional clinical data for potential risk factors. In 122 cases, adequate Rh-Ig prophylaxis was given, and clinical risk factors for fetal maternal hemorrhage (FMH) could be collected. Their clinical circumstances were compared to a control group of 339 randomly selected pregnant women. The Rh-Ig therapy failure of 57 of those women could not be explained through our risk factor analysis. From these 57 cases, DNA was obtained, and used for the FcγR-specific multiplex ligation-dependent probe amplification (MLPA) assay, identifying both single nucleotide polymorphisms and copy number variations in the FCGR locus. The results were compared to a control group of 200 healthy donors. Results: A history of red blood cell transfusion (p=0.05) and caesarean section (p<0.0001) were identified to be independent risk factors for RhD immunization. All other described risk factors for FMH such as miscarriage, termination of pregnancy, or invasive diagnostic procedures, requiring an additional Rh-Ig dose according to the guidelines, were not found to increase the risk of immunoprophylaxis failure. RhD-immunization due to caesarian section or red blood cell transfusion accounted for 53% of our cohort, suggesting an alternative explanation for the production of Rh-Ig alloantibodies in the remaining 47% of the cases - despite adequate amount of prophylaxis given in current and previous pregnancies. We therefore postulate the existence of a genetic variation that puts women at increased risk for RhD immunization during pregnancy. To test this hypothesis we analyzed the genetic variation in the FCGR locus and found a significantly (p=0.02) increased prevalence of the FCGR2 -ORF, expressing a functional copy of the activating FcγRIIc, which is otherwise a pseudogene. Strikingly, the prevalence of the 2B.4-promotor haplotype of the FCGR2B gene, associated with a 1.5 fold increase of the inhibitory FcγRIIb, was strongly (p=0.0001) increased. Conclusion: Caesarian section and red blood cell transfusion are risk factors that increase RhD immunization during pregnancies, accounting for about half failed Rh-Ig prophylactic cases. Genetic variation in the FCGR-gene might be a possible explanation for increased immunization risk. In our cohort we encountered a significantly increased frequency of individuals expressing FcγRIIc, along with a polymorphism encoding for a higher expression of the inhibitory receptor FcγRIIb, suggesting these genes to influence immune responses to RBC in a manner previously unrecognized. Disclosures No relevant conflicts of interest to declare.

Risk factors for postoperative blood transfusion after shoulder arthroplasty

2021 ◽  
pp. 175857322098225
Author(s):  
Kyle J Kopechek ◽  
Travis L Frantz ◽  
Joshua S Everhart ◽  
Richard Samade ◽  
Julie Y Bishop ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Shoulder Arthroplasty ◽  
Joint Infection ◽  
Multivariate Logistic Regression Analysis ◽  
Surgical Indication ◽  
Red Blood Cell Transfusion ◽  
Preoperative Hemoglobin ◽  
Postoperative Blood Transfusion

Purpose To identify the effect of surgical indication, patient factors, and perioperative characteristics on transfusion after shoulder arthroplasty (SA). Methods Shoulder arthroplasties for osteoarthritis (OA) ( N = 47), rotator cuff arthropathy (RCA) ( N = 50), fracture ( N = 76), revision ( N = 66), and periprosthetic joint infection (PJI) ( N = 35) performed at a single institution during a 6-year period were included. All other indications were excluded. Patient-based and surgical risk factors, including surgical indication, for postoperative allogeneic red blood cell transfusion were assessed with multivariate logistic regression analysis. Results A total of 274 SAs were included; transfusions were performed in 2% (2/97) of primary SAs for OA or RCA. Increased transfusion rates occurred in PJI (23%, p = 0.0006) and fracture (18%, p = 0.0018) cases. The mean preoperative hemoglobin (Hgb) was 12.2 ± 2.2 with PJI, 12.0 ± 2.1 with fracture, and 13.3 ± 1.6 g/dL for all other SAs. Independent risk factors for transfusion included lower preoperative hemoglobin ( p < 0.001), PJI indication ( p = 0.008), and fracture indication ( p = 0.02), with no difference for fracture greater or less than 4 weeks old ( p = 0.53). Conclusion Risk factors for allogeneic red blood cell transfusion after SA were low preoperative hemoglobin and procedures for PJI or fracture. Level of Evidence: Level III, retrospective case-control study

scholarly journals A Predictive Nomogram for Red Blood Cell Transfusion in Pheochromocytoma Surgery: A Study on Improving the Preoperative Management of Pheochromocytoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Ying Guo ◽  
Lili You ◽  
Huijun Hu ◽  
Anli Tong ◽  
Xiaoyun Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Treatment Duration ◽  
External Validation ◽  
Red Blood Cell Transfusion ◽  
Tumor Diameter ◽  
Preoperative Management ◽  
Good Discrimination ◽  
Internal Validation

PurposeSurgery is the major treatment option for pheochromocytoma but carries potential risks, including hemorrhage and hemodynamic instability. Even with laparoscopic adrenalectomy, intraoperative blood transfusion happens from time to time, but few studies have investigated risk factors. For the first time we develop and validate a nomogram for prediction of red blood cell transfusion in pheochromocytoma surgery.MethodsThere were 246 patients in our center and 56 patients in Peking Union Medical College Hospital, who underwent pheochromocytoma surgery, enrolled in the study. We incorporated clinical and radiological risk factors, and presented this with a nomogram. Lasso regression model was used for feature selection. Logistic regression analysis was performed to identify the odd ratios. The performance of the nomogram was assessed with respect to its discrimination, calibration and clinical usefulness.ResultsThirty-two features were reduced to five, which were phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction heart rate, tumor diameter and surgical procedure. The model showed good discrimination (C-index, 0.857; 95% CI, 0.781–0.836) and application in the validation sets also gave good discrimination (internal validation: C-index, 0.831; 95% CI, 0.750–0.822; external validation: C-index, 0.924; 95% CI, 0.766–1.000). Calibration tested with the Hosmer-Lemeshow test yielded a good agreement between prediction and observation (training P=0.358; internal validation P=0.205; external validation P=0.395). Odd ratios of phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction HR, tumor diameter and open surgery were 13.32 (95% CI, 1.48–197.38; P = 0.034), 1.04 (95% CI, 0.99–1.08; P = 0.092), 1.04 (95% CI, 1.01–1.08; P=0.006), 1.03 (95% CI, 1.02–1.06; P&lt;0.001), 17.13 (95% CI, 5.18–78.79; P&lt;0.001), respectively. Decision curve analysis demonstrated the clinical usefulness of the nomogram.ConclusionsThis study presents a nomogram that may be used to facilitate the prediction of red blood cell transfusion in pheochromocytoma surgery and help to do the preoperative management more efficiently.

scholarly journals Limited effect of red blood cell transfusion on long-term mortality among anaemic cardiac surgery patients

2020 ◽  
Vol 31 (3) ◽  
pp. 375-382
Author(s):  
Long Tran ◽  
Guri Greiff ◽  
Alexander Wahba ◽  
Hilde Pleym ◽  
Vibeke Videm
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Blood Cell ◽  
Red Blood Cell ◽  
World Health ◽  
Red Blood Cell Transfusion ◽  
Rbc Transfusion ◽  
Long Term Mortality

Abstract OBJECTIVES Our goal was to investigate long-term mortality associated with red blood cell (RBC) transfusion among patients with anaemia undergoing cardiac surgery when adjusting for known risk factors. METHODS Adults with preoperative anaemia as defined by World Health Organization criteria undergoing open-heart surgery from 2000 through 2017 were included. Cox regression was performed for long-term mortality (30 days–5 years), comparing patients who received ≥1 unit of RBC with those who did not. Unadjusted and multivariable analyses adjusted for risk factors were performed. RESULTS The study included 1859 patients, 1525 (82%) of whom received RBC transfusion. A total of 370 (19.9%) deaths were registered between 30 days and 5 years; 88 patients (23.8%) died between 30 days and 1 year. The unadjusted hazard ratio (HR) associated with RBC transfusion was 2.09 (1.49–2.93, P &lt; 0.001) from 30 days to 5 years postoperatively. The HR for RBC transfusion were 4.70 (1.72–12.81, P = 0.002) and 1.77 (1.23–2.55, P = 0.002) for 30 days–1 year and 1–5 years, respectively. Adjusting for perioperative risk factors, which included postoperative complications, the HR decreased to 1.16 (0.80–1.68, P = 0.43), 1.79 (0.63–5.12, P = 0.28) and 1.11 (0.75–1.65, P = 0.61) for observation time from 30 days to 5 years, 30 days to 1 year and 1 to 5 years, respectively. Results were similar when postoperative complications were excluded from the adjustment variables. CONCLUSIONS No statistically significant association between RBC transfusion and long-term mortality was found when we adjusted for known risk factors. This study suggests that the observed difference in mortality in this patient group is largely due to patient-related risk factors.

scholarly journals Risk factors of necrotizing enterocolitis in neonates with sepsis: A retrospective case-control study

2020 ◽  
Vol 34 ◽  
pp. 205873842096381
Author(s):  
Zheng-Li Wang ◽  
Yao An ◽  
Yu He ◽  
Xiao-Yu Hu ◽  
Lu Guo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Blood Cell ◽  
Necrotizing Enterocolitis ◽  
Red Blood Cell ◽  
Late Onset ◽  
Univariate Analysis ◽  
Red Blood Cell Transfusion ◽  
Control Group ◽  
Retrospective Case

Sepsis, a severe infectious disease in the neonatal period, is considered a risk factor for necrotizing enterocolitis (NEC). To investigate the specific risk factors for NEC in septic infants, septic infants admitted to our center from January 2010 to April 2018 were included. Septic neonates with proven NEC (Bell’s stage ⩾II) were enrolled in the NEC group, and those without NEC were enrolled in the control group. Demographics, clinical characteristics, and risk factors were compared between the two groups. Univariate and logistic regression analyses were used to evaluate the potential risk factors for NEC. A total of 610 septic neonates were included, of whom 78 (12.8%) had complicated NEC. The univariate analysis indicated that infants with NEC had a lower birth weight, a lower gestational age, and older age on admission than those without NEC ( P < 0.05). Higher rates of anemia, prolonged rupture of membranes (PROM) (⩾18 h), pregnancy-induced hypertension, late-onset sepsis (LOS), red blood cell transfusion and hypoalbuminemia were observed in the NEC group than in the non-NEC group (P<0.05). Logistic regression analysis revealed LOS ( P = 0.000), red blood cell transfusion ( P = 0.001) and hypoalbuminemia ( P = 0.001) were associated with the development of NEC. Among NEC infants, those who needed red blood cell transfusion had a longer hospitalization duration than those who did not need transfusion ( P < 0.05). LOS, red blood cell transfusion and hypoalbuminemia were independent risk factors for the development of NEC in infants with sepsis. Taking measures to reduce the occurrence of hypoproteinemia and severe anemia may help to reduce the occurrence of NEC in septic neonates.

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