BackgroundPrevious studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a... Show moreBackgroundPrevious studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery.MethodsA nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis.ResultsIn total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4–1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3–1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4–2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction.ConclusionsPreoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes. Show less
Tonino, R.P.B.; Wilson, M.; Zwaginga, J.J.; Schipperus, M.R. 2021
Background and Objectives While iron deficiency (ID) is the most common cause of anaemia, little is known about the prevalence and type of ID in preoperative surgical patients. The aims of the... Show moreBackground and Objectives While iron deficiency (ID) is the most common cause of anaemia, little is known about the prevalence and type of ID in preoperative surgical patients. The aims of the present study were to investigate the prevalence and types of ID in a large cohort of surgical patients, and how these are related to perioperative blood use after correction for confounders such as haemoglobin level. Materials and Methods Data were retrospectively extracted from electronic case records of all patients who underwent elective surgery between September 2016 and November 2017 (n = 2711). Iron parameters, haemoglobin and details of perioperative red cell transfusions were collected. Results Of 2711 patients, 618 (22.8%) were iron deficient (= transferrin saturation [TSAT] < 16%) preoperatively, 173 (6.4% of the cohort) had an absolute iron deficiency (AID; TSAT < 16% and ferritin < 30 mu g/L) and 445 (16.4%) had functional/mixed ID (TSAT < 16% and ferritin >= 30 mu g/L). Corrected for Hb level, iron-deficient patients received significantly more red cell units than patients without ID (p = 0.026). AID was not associated with a significantly higher incidence of transfusions (7.5% of patients transfused; p = 0.12 after correction for Hb) than patients without ID, whereas patients with functional/mixed deficiency did receive significantly more transfusions (6.1%; p = 0.021) as compared to patients without ID (1.7%). Conclusion Preoperative ID, in particular the functional/mixed type, was associated with a higher risk of receiving perioperative red cell transfusions as compared to patients without ID. Adequately treating ID might, therefore, reduce the need for perioperative red cell transfusions. Show less
Kranenburg, F.J.; Cessie, S. le; Caram-Deelder, C.; Bom, J.G. van der; Arbous, M.S. 2019
Background and ObjectivesThe aim of this study was to assess potentially relevant clinical characteristics which influence the decision to transfuse red cells in critically ill patients with low... Show moreBackground and ObjectivesThe aim of this study was to assess potentially relevant clinical characteristics which influence the decision to transfuse red cells in critically ill patients with low haemoglobin concentrations (6.0–10.0 g/dl).Materials and MethodsThis was a retrospective observational cohort study of patients admitted between November 2004 and May 2016 at the intensive care unit (ICU) of the Leiden University Medical Center, Netherlands. Haemoglobin measurements, clinical variables and the subsequent transfusion decision were extracted from the electronic health records. Clinical variables were grouped by organ system. We first examined the association of each of the clinical variables with the decision to transfuse during the following 6 h after a haemoglobin measurement using generalized estimating equations. We then compared the predictive abilities of single variables within an organ system and the predictive ability of an organ system’s combined variables using the change in Akaike information criterion (AIC).ResultsA total of 83 394 haemoglobin measurements of 10 947 ICU admissions were included. Haemoglobin concentration was the most predictive for red cell transfusion. After the haemoglobin concentration, the combined variables for General Health, followed by the organ systems Cardiovascular and Pulmonary, were most predictive for red cell transfusion. Within these organ systems, the APACHE II score, referring department, APACHE admission diagnosis subgroup, troponin concentration, lactate concentration, respiratory rate, PaO2/FiO2 and ventilation mode had the highest predictive ability.ConclusionHaemoglobin concentration is the dominant predictor for red cell transfusion. Other clinical characteristics are also predictive, though to a lesser extent. Show less
Ree, I.M.C.; Haas, M. de; Middelburg, R.A.; Zwiers, C.; Oepkes, D.; Bom, J.G. van der; Lopriore, E. 2019
Malaria was an important disease in the history of The Netherlands, especially in the coastal, marshy regions. However, malaria is only rarely included in archaeological discussions about past... Show moreMalaria was an important disease in the history of The Netherlands, especially in the coastal, marshy regions. However, malaria is only rarely included in archaeological discussions about past Dutch disease, most likely because it does not result in any pathognomonic skeletal lesions. Since anaemia is one of the main symptoms of malaria, cribra orbitalia could be formed in response to the disease. Currently, these orbital lesions are often used in osteoarchaeological research as a non-specific stress marker. However, if malaria can be responsible as well, as suggested by Gowland and Western (2012) for England, interpretations of cribra orbitalia in Dutch research are incomplete and need to be reconsidered. Therefore, this paper will analyse the relationship between cribra orbitalia and marshy areas in the medieval Netherlands to investigate if malaria is likely to have been a causative agent. To do this, cribra orbitalia prevalence is studied in three skeletal collections and supplemented by data published in osteological reports (total: n=1838), which are then linked to geological characteristics. Results indicate a significant correlation (p=<0.001) between the orbital pathology and areas that are deemed malarial, suggesting that malaria was an important illness in these regions of The Netherlands. The results of this poster illustrate the potential limitations of using cribra orbitalia as a non-specific stress marker and demonstrate that combining archaeological context with osteological data can be a way forward in research into the true causative agents of markers of non-specific stress. Show less
