Transfusion of Red Blood Cells, Fresh Frozen Plasma, or Platelets Is Associated With Mortality and Infection After Cardiac Surgery in a Dose-Dependent Manner

Abstract

BACKGROUND: It is unclear whether transfusion of platelets or fresh frozen plasma, in addition to red blood cells, is associated with an increased risk of mortality and infection after cardiac surgery. METHODS: Patients who underwent valve surgery and/or coronary artery bypass grafting from January 1, 2011 to June 30, 2017 and September 1, 2013 to June 30, 2017 at 2 centers performing cardiac surgery were included in this retrospective study. After stratifying patients based on propensity score matching, we compared rates of mortality and infection between patients who transfused red blood cells, fresh frozen plasma, or platelets with those who did not receive such transfusions. We also compared outcomes between patients who received any of the 3 blood products and patients who received no transfusions at all. Multivariable logistic regression was used to assess associations between transfusion and outcomes. RESULTS: Of 8238 patients in this study, 109 (1.3%) died, 812 (9.9%) experienced infection, and 4937 (59.9%) received at least 1 type of blood product. Transfusion of any blood type was associated with higher rates of mortality (2.0% vs 0.18%; P < .01) and infection (13.3% vs 4.8%; P < .01). Each of the 3 blood products was independently associated with an increase in mortality per unit transfused (red blood cells, odds ratio 1.18, 95% confidence interval [CI], 1.14–1.22; fresh frozen plasma, odds ratio 1.24, 95% CI, 1.18–1.30; platelets, odds ratio 1.12, 95% CI, 1.07–1.18). Transfusing 3 units of any of the 3 blood products was associated with a dose-dependent increase in the incidence of mortality (odds ratio 1.88, 95% CI, 1.70–2.08) and infection (odds ratio 1.50, 95% CI, 1.43–1.57). CONCLUSIONS: Transfusion of red blood cells, fresh frozen plasma, or platelets is an independent risk factor of mortality and infection, and combination of the 3 blood products is associated with adverse outcomes after cardiac surgery in a dose-dependent manner.

Platelet transfusion is associated with 90‐day and 1‐year mortality for adult patients requiring veno‐arterial extracorporeal membrane oxygenation

“…Several other studies reported similar associations of PLT transfusion in a variety of patient populations. PLT transfusion has been shown to be significantly associated with increased infection in patients undergoing cardiac surgery [32]. In a study of 511 children requiring ECMO, their findings were quite similar to our study for PLT transfusion and its association with mortality [33].…”

Association between red blood cell transfusion dependence and burden in patients with myelodysplastic syndromes: A systematic literature review and meta‐analysis

“…These deaths, according to a recent study, may include deaths from infection, bleeding, and cardiovascular issues 19 . Indeed, transfusion of RBCs has been shown to be an independent risk factor of infection and mortality 62 …”

Robotic mitral valve operations can be safely performed in obese patients

“…Although the only case with mortality was observed in obese patients, this difference was not significant and the perioperative variables for this specific patient was similar with non obese patients and no technical issue was experienced. Bleeding and amount of blood transfusions were also similar which are important in limiting overall and infection‐specific adverse events 13,14 . Reser et al 15 who have compared their patients of different BMIs undergoing minimally invasive mitral surgery observed increased ventilation times in their patients with BMI > 30, which did not result in increased adverse events nonetheless.…”