Journal article
Iron deficiency is associated with higher mortality in patients undergoing cardiac surgery: a prospective study.
- Rössler J Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
- Schoenrath F Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany.
- Seifert B Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
- Kaserer A Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
- Spahn GH Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
- Falk V Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland.
- Spahn DR Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland. Electronic address: donat.spahn@usz.ch.
- 2019-11-01
Published in:
- British journal of anaesthesia. - 2020
adverse events
anaemia
mortality
patient blood management
preoperative
surgical risk
transfusion
Adult
Aged
Aged, 80 and over
Anemia, Iron-Deficiency
Blood Transfusion
Cardiac Surgical Procedures
Cerebrovascular Disorders
Female
Ferritins
Heart Diseases
Humans
Incidence
Iron
Length of Stay
Male
Middle Aged
Postoperative Complications
Prospective Studies
Treatment Outcome
English
BACKGROUND
Iron deficiency is frequent in patients undergoing cardiac surgery. The relevance of iron deficiency, however, is ill defined. Therefore, our study aimed to investigate the impact of iron deficiency (ferritin <100 μg L-1) with or without concomitant anaemia on clinical outcome after cardiac surgery.
METHODS
In this prospective observational study, 730 patients undergoing elective cardiac surgery were assigned into four groups according to their iron status and anaemia. Mortality, serious adverse events (SAEs), major cardiac and cerebrovascular events (MACCEs), allogenic blood transfusion requirements, and length of hospital stay were assessed during a 90-day follow-up period. The effect of iron deficiency on these outcomes was first calculated in models adjusting for anaemia only, followed by two multivariate models adjusting for anaemia and either the EuroSCORE II or any possible confounders.
RESULTS
The presence of iron deficiency (ferritin <100 μg L-1) was associated with an increase in 90-day mortality from 2% to 5% in patients without anaemia, and from 4% to 14% in patients with anaemia. Logistic regression resulted in an odds ratio of 3.5 (95% confidence interval: 1.5-8.4); P=0.004. The effect persisted in both multivariate models. Moreover, iron deficiency was associated with an increased incidence of SAEs, MACCEs, transfusion, and prolonged hospital stay.
CONCLUSIONS
Preoperative iron deficiency (ferritin <100 μg L-1) was independently associated with increased mortality, more SAEs, and prolonged hospital stay after cardiac surgery. These findings underline the importance of preoperative iron deficiency screening in the context of a comprehensive patient blood management programme, and highlight its importance as a research topic in cardiac surgery.
CLINICAL TRIAL REGISTRATION
NCT02031289.
Iron deficiency is frequent in patients undergoing cardiac surgery. The relevance of iron deficiency, however, is ill defined. Therefore, our study aimed to investigate the impact of iron deficiency (ferritin <100 μg L-1) with or without concomitant anaemia on clinical outcome after cardiac surgery.
METHODS
In this prospective observational study, 730 patients undergoing elective cardiac surgery were assigned into four groups according to their iron status and anaemia. Mortality, serious adverse events (SAEs), major cardiac and cerebrovascular events (MACCEs), allogenic blood transfusion requirements, and length of hospital stay were assessed during a 90-day follow-up period. The effect of iron deficiency on these outcomes was first calculated in models adjusting for anaemia only, followed by two multivariate models adjusting for anaemia and either the EuroSCORE II or any possible confounders.
RESULTS
The presence of iron deficiency (ferritin <100 μg L-1) was associated with an increase in 90-day mortality from 2% to 5% in patients without anaemia, and from 4% to 14% in patients with anaemia. Logistic regression resulted in an odds ratio of 3.5 (95% confidence interval: 1.5-8.4); P=0.004. The effect persisted in both multivariate models. Moreover, iron deficiency was associated with an increased incidence of SAEs, MACCEs, transfusion, and prolonged hospital stay.
CONCLUSIONS
Preoperative iron deficiency (ferritin <100 μg L-1) was independently associated with increased mortality, more SAEs, and prolonged hospital stay after cardiac surgery. These findings underline the importance of preoperative iron deficiency screening in the context of a comprehensive patient blood management programme, and highlight its importance as a research topic in cardiac surgery.
CLINICAL TRIAL REGISTRATION
NCT02031289.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.bja.2019.09.016
- PMID 31668348
- Persistent URL
- https://folia.unifr.ch/global/documents/121878
Statistics
Document views: 43
File downloads: