Perioperative red blood cell transfusion is associated with poor functional outcome and overall survival in patients with newly diagnosed glioblastoma

Matthias Schneider,Christina Schaub,Ulrich Herrlinger,Elisa Scharnböck,Muriel Heimann,Lars Eichhorn,Leonie Weinhold,Niklas Schäfer,Felix Lehmann,Anna-Laura Potthoff,Johannes Weller,Patrick Schuss,Hartmut Vatter,Erdem Güresir

doi:10.1007/s10143-021-01633-y

Abstract

The influence of perioperative red blood cell (RBC) transfusion on prognosis of glioblastoma patients continues to be inconclusive. The aim of the present study was to evaluate the association between perioperative blood transfusion (PBT) and overall survival (OS) in patients with newly diagnosed glioblastoma. Between 2013 and 2018, 240 patients with newly diagnosed glioblastoma underwent surgical resection of intracerebral mass lesion at the authors’ institution. PBT was defined as the transfusion of RBC within 5 days from the day of surgery. The impact of PBT on overall survival was assessed using Kaplan–Meier analysis and multivariate regression analysis. Seventeen out of 240 patients (7%) with newly diagnosed glioblastoma received PBT. The overall median number of blood units transfused was 2 (95% CI 1–6). Patients who received PBT achieved a poorer median OS compared to patients without PBT (7 versus 18 months; p < 0.0001). Multivariate analysis identified “age > 65 years” (p < 0.0001, OR 6.4, 95% CI 3.3–12.3), “STR” (p = 0.001, OR 3.2, 95% CI 1.6–6.1), “unmethylated MGMT status” (p < 0.001, OR 3.3, 95% CI 1.7–6.4), and “perioperative RBC transfusion” (p = 0.01, OR 6.0, 95% CI 1.5–23.4) as significantly and independently associated with 1-year mortality. Perioperative RBC transfusion compromises survival in patients with glioblastoma indicating the need to minimize the use of transfusions at the time of surgery. Obeying evidence-based transfusion guidelines provides an opportunity to reduce transfusion rates in this population with a potentially positive effect on survival.

Highlights

Perioperative anemia requires the transfusion of red blood cells (RBC) after reaching an individual threshold value, which often varies considerably for interhospitalEspecially in the context ofelective intracranial surgical procedures, current efforts in patient blood management are aimed at raising the thresholds for transfusions while maintaining patient safety, leading to a controversy between restrictive and liberal transfusion strategies [11]
Regarding extent of resection (EOR), Gross total resection (GTR) was achieved in 164 patients (68%), while subtotal resection (STR) was achieved in 76 patients (32%)
ASA, American Association of Anesthesiologists; CCI, Charlson Comorbidity Index; CRP, C-reactive protein; d, day; GTR, gross total resection; Hb, hemoglobin; Karnofsky Performance Score (KPS), Karnofsky Performance Scale; mons, months; PBT, perioperative blood transfusion; RBC, red blood cell; WBC, white blood cell; yr(s), year(s) to the age-adjusted CCI

Summary

Introduction

Perioperative anemia requires the transfusion of red blood cells (RBC) after reaching an individual threshold value, which often varies considerably for interhospitalEspecially in the context of (semi-)elective intracranial surgical procedures, current efforts in patient blood management are aimed at raising the thresholds for transfusions while maintaining patient safety, leading to a controversy between restrictive and liberal transfusion strategies [11]. Perioperative anemia requires the transfusion of red blood cells (RBC) after reaching an individual threshold value, which often varies considerably for interhospital. Perioperative anemia with concomitant oxygen starvation and endangerment of important organ functions must be assessed individually against a potentially harmful interaction or reactions of the blood transfusions that need to be carried out [1, 16]. We aimed at assessing a potential correlation of PBT and further pre- and intraoperatively collectable variables with impaired functional outcome and worsened overall survival in patients that had undergone neurosurgical resection of newly diagnosed glioblastoma at our institution. The threshold values for RBC transfusions in clinically stable patients were specified at a hemoglobin (Hb) concentration of < 7 g/dL, following the current consensus recommendations of patient blood management [18]

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