Predictors Of Blood Transfusion Research Articles

A vértranszfúzió gyakorisága primer csípőprotézis-beültetés után

Introduction: Total hip arthroplasty is one of the most common surgical procedures that requires blood transfusion, with the possible risk of significant complications. Aim: A retrospective study was performed to analyze the predictors of blood transfusion after primary total hip arthroplasty. Method: We collected the data of 210 consecutive patients undergoing total hip arthroplasty. Patient's data, preoperative hemoglobin and hematocrit level, the type of the prosthesis, the use of a suction drain, tranexamic acid or anticoagulants and the type and amount of blood transfusion were recorded. Results: A total of 41% of our patients required transfusion, 8.6% receiving allogenic blood. Significant predictors of allogenic blood transfusion were preoperative hemoglobin and hematocrit levels, the type of prosthesis, the use of suction drainage and the use of tranexamic acid. Patients with pre-donated autologous blood did not require allogenic blood transfusion. Conclusion: Based on our study, total hip arthroplasty necessitates allogenic blood transfusion in 8.6%. Major predictors associated with the need for transfusion are preoperative hemoglobin and hematocrit levels, the type of prosthesis, the use of suction drainage and the use of tranexamic acid. Pre-donated autologous blood helps to reduce allogenic transfusion rate. Orv Hetil. 2020; 161(8): 290-294.

Development of a Nomogram for Predicting Blood Transfusion Risk After Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients.

BackgroundThe aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs).Material/MethodsWe performed a retrospective study including consecutive elderly FNF patients treated by HA between January 2015 and December 2017. Perioperative information was obtained retrospectively, uni- and multivariate regression analyses were conducted to determine risk factors for blood transfusion, and a nomogram model was constructed to predict the risk of blood transfusion. The predictive performance and consistency of the model were evaluated by the consistency coefficient (C-index) and the calibration curve, respectively.ResultsOf 178 patients, 151 were finally enrolled in the study and 21 received blood transfusion. Binary logistic regression analysis showed the low preoperative hemoglobin (Hb), longer time to surgery, general anesthesia, longer surgery duration, and higher intraoperative blood loss (IBL) were risk factors for blood transfusion. The accuracy of the contour map for predicting transfusion risk was 0.940.ConclusionsWe found a correlation between blood transfusion requirement and low preoperative Hb, longer time to surgery, general anesthesia, longer surgery duration, and higher IBL, and we then developed a nomogram. Our nomogram model can be used to evaluate the transfusion risk for FNF patients after HA, and provides better guidance for clinicians to intervene perioperatively, so as to reduce the incidence of blood transfusion.

176: Applications for shock index in obstetrics

Evaluation of post-partum blood loss is traditionally inaccurate. Shock index, a common tool used in the trauma setting to identify patients at risk for massive transfusion, is defined as heart rate divided by systolic blood. Our objective is to evaluate postpartum shock index (SI) values between women who did and did not require blood transfusion due to postpartum hemorrhage (PPH) as a useful tool in obstetrics. This is a retrospective case control study of women who delivered at a single institution in 2018. Delivery data, quantified blood loss (QBL), maternal outcomes data, and vital signs were collected throughout the first 30 minutes postpartum. Primary outcome is to define normal SI at term. Secondary outcomes analyze association between SI and QBL. Analysis was performed using Wilcoxon rank-sum test, and linear, univariate and multivariate regression. Log scaling was applied due to skewness in data. 126 women were studied: 80 experienced PPH and 20 required transfusion. Normal SI at term was 0.7 (Range 0.4-1.1). Increase in SI value was associated with increasing blood loss. For every 0.1 incremental increase in SI, the RR of blood loss was 1.06. SI > 0.9 at 30 minutes postpartum was significantly associated with need for blood transfusion (p 0.003). As a predictor of blood transfusion, this SI 30 minutes postpartum of > 0.9 had PPV value of 26% and NPV of 89%. Increased SI values were associated with greater volume of blood loss and need for blood transfusion in both vaginal and cesarean deliveries. SI predicts need for blood transfusion in women after vaginal or cesarean delivery. SI is positively correlated with intra-partum blood loss. SI is easily obtained and reproducible at the time of delivery. Postpartum SI may be a clinically useful tool in obstetrics.

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

PurposeWe aimed to assess the utility of shock index (SI) to predict the need for massive transfusion protocol (MTP) in patients with solid organ injury (SOI) in a Level 1 Trauma center.MethodsWe conducted a retrospective analysis for patients with SOI between 2011 and 2014. Patients were categorized according to on-admission SI into low (< 0.8) and high SI (≥0.8) group.ResultsA total of 4500 patients were admitted with trauma, of them 572 sustained SOIs (289 patients had SI ≥0.8). In comparison to low SI, patients with high SI were younger, had higher injury severity scores (ISS) and lower Trauma and Injury Severity Score (TRISS); (p < 0.001). The proportion of exploratory laparotomy (EXLap), blood transfusion (BT), MTP activation, sepsis and hospital mortality were significantly higher in patients with high SI. Serum lactate (r = 0.34), hematocrit (r = − 0.34), ABC score (r = 0.62), ISS (r = 0.35), and amount of transfused blood (r = 0.22) were significantly correlated with SI. On multivariable regression analysis using 9 relevant variables (age, sex, ISS, ED GCS, serum lactate, hematocrit, Abdomen AIS and Focused assessment with sonography in trauma (FAST) and SI), SI ≥ 0.8 was an independent predictor of BT (OR 2.80; 95%CI 1.56–4.95) and MTP (OR 2.81;95% CI 1.09–7.21) .ConclusionsIn patients with SOI, SI is a simple bedside predictor for BT and MTP activation. Further prospective studies are needed to support our findings.

Predictors of blood transfusion in autologous breast reconstruction surgery: A retrospective study using the nationwide inpatient sample database

Specific risk factors associated with the use of blood transfusions during and following autologous breast reconstruction are unknown. The purpose of this study was to evaluate the rate of blood transfusion in autologous breast reconstruction and identify independent risk factors of blood transfusion in autologous breast reconstruction. A cohort of patients who had undergone autologous breast reconstruction was identified using the Nationwide Inpatient Sample database from 2012 to 2014 in the United States. Univariate and multivariate regression analyses were performed to identify independent risk factors of blood transfusion in this patient population. A total of 55,840 patients underwent autologous breast reconstruction surgery during this period. The overall rate of blood transfusion was 7.0%. Multivariate regression analysis showed that chronic anemia (adjusted odds ratio [AOR], 5.17), congestive heart failure (AOR, 4.07), free flap (AOR, 2.03), chronic kidney disease (AOR, 1.79), hypertension (AOR, 1.39), chronic lung disease (AOR, 1.23), diabetes mellitus (AOR, 1.21), non-teaching hospital (AOR, 1.20), and obesity (AOR, 1.12) were significant risk factors of blood transfusion. There was no association between age, race, liver disease, smoking, chemotherapy, or reconstruction-time on blood transfusion. Patients who received blood transfusion had a significantly higher overall complication rate, longer length of hospital stay, and higher costs than patients who did not receive blood transfusion. The rate of blood transfusion in autologous breast reconstruction is noticeable (7.0%). Improved awareness of these common risk factors can allow surgeons to identify patients with higher risk to attempt to mitigate complications.

A comparative study of viscoelastic hemostatic assays and conventional coagulation tests in trauma patients receiving fibrinogen concentrate

BackgroundBoth thrombelastography (TEG) and rotational thromboelastometry (ROTEM) have been investigated for diagnosis of coagulopathy and guidance of resuscitation in trauma and surgery. Given similarities between the two systems, it is important to determine whether one is superior to the other and how comparable they are to conventional coagulation tests (CCTs). Therefore, we conducted a comparative study of functional fibrinogen and coagulation assays using TEG and ROTEM and CCTs to determine their capability to monitor coagulation profiles, diagnose coagulopathy and predict blood transfusion requirements in trauma patients. MethodsBlood samples were collected from 45 patients at admission and during 48-h hospitalization as part of a randomized control trial on early fibrinogen replacement in trauma. Functional fibrinogen (FF) TEG, ROTEM FIBTEM and EXTEM, and CCTs were performed and compared. ResultsWe found significant differences between the placebo and fibrinogen groups over hospitalization time in FF TEG MA, ROTEM CT, MCF and LI30. FF TEG MA and ROTEM FIBTEM MCF mirrored plasma fibrinogen profiles, reached a maximum difference between the two groups 1–3 h after fibrinogen administration. In comparison, CCTs detected minimal hemostatic changes by fibrinogen treatment. TEG and ROTEM showed various degrees of correlations with CCTs. TEG MA and ROTEM MCF provided better predictions for plasma and RBC transfusions than CCTs, but poor accuracy for cryoprecipitate transfusion. Both TEG and ROTEM well predicted hypofibrinogenemia (fibrinogen concentration < 1 g/L), but poorly detected coagulopathy (INR ≥ 1.2). ConclusionsTEG and ROTEM detected increases in clot strength following early use of fibrinogen. ROTEM also detected changes in coagulation time and clot lysis. Both were better than CCTs for monitoring coagulation profiles and predicting transfusion requirements.

Hematologic profile in reverse total shoulder arthroplasty: perioperative and postoperative blood loss

Few studies have investigated the amount of blood loss during reverse total shoulder arthroplasty (RTSA). The purpose of this study was to investigate blood loss in patients who underwent RTSA for massive irreparable rotator cuff tear (MIRCT)using the hemoglobin (Hb) balancemethod and total Hemovac amount and to identify predictors of blood transfusion in these patients. We retrospectively reviewed 121 patients who underwent RTSA for MIRCT. The mean age was 71.2 ± 6.9 years, and 75 were women. Age, sex, body mass index, use of anticoagulants, American Society of Anesthesiologists physical status score, comorbidities (eg, hypertension, diabetes mellitus, cerebrovascular accident), preoperative Hb level, preoperative hematocrit level, preoperative prothrombin time/international normalized ratio, use of cement, and operative time were evaluated as values predicting blood transfusion. The overall blood loss was 846.6 ± 527.6 mL, which included 346 ± 231.2 mL of intraoperative blood loss and 500.3 ± 196.4 mL of postoperative blood loss. Values predicting blood transfusion were a lower preoperative Hb level (P < .001), hematocrit level (P < .001), hypertension (P = .018), and cerebrovascular accident (P = .008). Receiver operating characteristic analysis identified the following cutoff values for predicting transfusion: preoperative Hb level of 13.5 g/dL (90.3% sensitivity) and hematocrit of 40% (90.3% sensitivity). RTSA for MIRCT is associated with blood loss during and after surgery. The amount of blood loss should be noted, and blood transfusion could be predicted by calculating the blood loss and predictive values. Lower preoperative Hb level, hematocrit, hypertension, and cerebrovascular accident are predictors of blood transfusion. Blood transfusion should be considered if a patient with preoperative Hb level <13.5 g/dL and hematocrit <40% has a history of hypertension or cerebrovascular accident.

Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis.

Gastric antral vascular ectasia (GAVE) is a rare cause of chronic non-variceal upper gastrointestinal (GI) bleeding and can turn into life-threatening bleed in some patients. Packed red blood cell (PRBC) transfusions are often required in these patients during hospitalization. We aimed to investigate the hospitalization outcomes and predictors of PRBC transfusions in patients with GAVE lesions. Using the ICD-9-CM codes (537.82, 537.83), we queried the National Inpatient Sample (NIS) [2010-2014] to recognize hospitalized GAVE patients. A 1:2 random sample was obtained from the non-GAVE cohort and these groups were compared (GAVE vs. non-GAVE). The predictors of PRBC transfusion in GAVE cohort were analyzed with multivariate analysis by using SPSS Statistics 22.0. We included weighted 89,081 GAVE and 178,550 non-GAVE hospitalized patients. The GAVE patients were tended to be older, female and white. Significantly higher proportions of comorbidities such as congestive heart failure, diabetes, hypertension, hypothyroidism, liver disease, renal failure, Sjogren syndrome, systemic sclerosis and portal hypertension, etc. were present in these patients. The all-cause inpatient mortality was found to be 1.4%. The mean hospital charges and length of stay (LOS) per GAVE hospitalization were $36,059 and 4.63±5.3 days, respectively. A total of 6,276 (weighted 31,102) (34.9%) of these patients received at least one PRBC transfusion during hospitalization. Advanced age, multiple comorbidities, non-elective admissions, male gender, and African American race were the independent factors associated with higher chances of receiving PRBC transfusion. Our analysis showed that hospitalized patients with GAVE lesions had lower overall mortality rate despite having multiple comorbidities. There was no difference in the LOS and hospital charges between the two cohorts. Nearly 35% of the GAVE patients received at least one PRBC transfusion.

Maternal predictors of blood transfusion among neonates in the Neonatal Intensive Care Unit of Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Background: Maternal health and healthcare accessibility are important determinants of neonatal survival. Pregnancy-related complications may lead to maternal anemia and, maternal micronutrient deficiency, conditions which could result in neonatal anemia necessitating transfusion. Objectives: To determine maternal predictors of neonatal blood transfusion. Methods: We conducted a case–control study on mother–infant pairs of cases and controls. A semi-structured questionnaire was used to collect information. Logistic regression was used on maternal predictors, and the level of significance was set at ≤0.05. Results: The overall mean (±standard deviation) age of mothers in both case and control groups was 21.79 ± 10.71 years, respectively. The likelihood of neonatal transfusion was increased by parity of ≥5 [odds ratio (OR): 3.1, 95% confidence interval (CI) = 1.26–7.39], while age of ≥18 years at first marriage, attainment of at least secondary school, four antenatal care (ANC) visits before delivery, birth interval of ≥2 years, and hematinics use during pregnancy were associated with reduced neonatal blood transfusion (OR: 0.36, 95% CI = 0.14–0.96), (OR: 0.66, 95% CI = 0.32–1.37), (OR: 0.70, 95% CI = 0.25–1.99), (OR: 0.55, 95% CI = 0.19–1.62), and (OR: 0.63, 95% CI = 0.17–2.36), respectively. Conclusion: We found that high parity, teenage mothers, inadequate ANC visits, short birth interval, and hematinics noncompliance during pregnancy were all associated with increased need of blood transfusion among neonates.

Approaches on the Major Predictors of Blood Transfusion in Cardiovascular Surgery: A Systematic Review

Introduction: Experimental Clinical studies have shown that loss of up to 77.0% of red cell mass can be tolerated as long as it kept the blood volume. However, the blood volume loss of about 34.0% is fatal. The initial attention in patients with bleeding should be given to maintaining blood volume and oxygen transport. Thus, transfusions of allogeneic blood products are associated with an increased risk of morbidity and mortality in cardiac surgery. Some transfusion risk scores have been proposed for cardiac surgery patients. Objective: To review and discuss literature blood transfusion (blood components gradient) in cardiovascular surgery versus polytrauma, gastrointestinal bleeding, and neoplastic diseases. Methods: The model followed for the review was PRISMA. We used the databases as Scielo, Lilacs, Google Scholar, PubMed articles and works of scientific and doctoral theses master. Results: According to the discussion in the literature, the acute bleeding of large volumes is challenging to emergency services. Accordingly, the need to support hemotherapeutics led to the development of protocols for more rational utilization of the monitored blood components. Conclusion: Hemotherapy services have adopted a very dynamic approach to the clinical condition presented by patients, the need for four or more red blood cell units.

Validation of a score to predict blood transfusion following pancreatoduodenectomy demonstrates distinct risk factors for early and late transfusion

Validation of a score to predict blood transfusion following pancreatoduodenectomy demonstrates distinct risk factors for early and late transfusion

Validation of a score to predict blood transfusion following pancreatoduodenectomy demonstrates distinct risk factors for early and late transfusion

Validation of a score to predict blood transfusion following pancreatoduodenectomy demonstrates distinct risk factors for early and late transfusion

A preoperative risk score to predict red blood cell transfusion in patients undergoing hysterectomy for ovarian cancer

Patients with ovarian cancer experience a high rate of anemia throughout their treatment course, with rates that range from 19-95%. Blood transfusions offer symptom relief but may be costly, are limited in supply, and have been associated with worse 30-day surgical morbidity and mortality rates. The purpose of this study was to identify risk factors for blood transfusion with packed red blood cell and to develop a transfusion risk score to identify patients who undergo surgery for ovarian cancer and who are at lowest risk for a blood transfusion. Our aim was to help clinicians identify those patients who may not require a crossmatch to encourage resource use and cost-savings. This is a retrospective database cohort study of 3470 patients who underwent hysterectomy for ovarian cancer with the use the National Surgical Quality Improvement Program database from 2014-2016. The association between risk factors with respect to 30-day postoperative blood transfusion was modeled with the use of logistic regression. A risk score to predict blood transfusion was created. Eight hundred ninety-one (25.7%) patients received a blood transfusion. In multivariate analysis, blood transfusion was associated independently with age (odds ratio, 1.90, P<.01), African American race (odds ratio, 2.30; P<.01), ascites (odds ratio, 1.89; P=.02), preoperative hematocrit level <30% (odds ratio, 10.70; P<.01), preoperative platelet count >400×109/L (odds ratio, 1.75; P<.01), occurrence of disseminated cancer (odds ratio, 1.71; P<.01), open surgical approach (odds ratio, 7.88; P<.01), operative time >3 hours (odds ratio, 2.19; P<.01), and additional surgical procedures that included large bowel resection (odds ratio, 4.23; P<.01), bladder/ureter resection (odds ratio, 1.69; P=.02), and pelvic exenteration (P=.02). A preoperative risk score that used age, race, ascites, preoperative hematocrit level, platelets, presence of disseminated cancer, planned hysterectomy approach, and procedures accurately predicted blood transfusion with good discriminatory ability (C-statistic=0.80 [P<.001]; C-statistic=0.69 [P<.001] for derivation and validation datasets, respectively) and calibration (Hosmer-Lemeshow goodness-of-fit, P=.081; P=.56 for derivation and validation datasets, respectively). Patients who undergo hysterectomy for ovarian cancer experience a high incidence of blood transfusions in the perioperative period. Preoperative risk factors and planned surgical procedures can be used in our transfusion risk score to help predict anticipated blood requirements.

Predictive Modeling for Blood Transfusion After Adult Spinal Deformity Surgery: A Tree-Based Machine Learning Approach.

Retrospective cohort study. Blood transfusion is frequently necessary after adult spinal deformity (ASD) surgery. We sought to develop predictive models for blood transfusion after ASD surgery, utilizing both classification tree and random forest machine-learning approaches. Past models for transfusion risk among spine surgery patients are disadvantaged through use of single-institutional data, potentially limiting generalizability. This investigation was conducted utilizing the American College of Surgeons National Surgical Quality Improvement Program dataset years 2012 to 2015. Patients undergoing surgery for ASD were identified using primary-listed current procedural terminology codes. In total, 1029 patients were analyzed. The primary outcome measure was intra-/postoperative blood transfusion. Patients were divided into training (n = 824) and validation (n = 205) datasets. Single classification tree and random forest models were developed. Both models were tested on the validation dataset using area under the receiver operating characteristic curve (AUC), which was compared between models. Overall, 46.5% (n = 479) of patients received a transfusion intraoperatively or within 72 hours postoperatively. The final classification tree model used operative duration, hematocrit, and weight, exhibiting AUC = 0.79 (95% confidence interval 0.73-0.85) on the validation set. The most influential variables in the random forest model were operative duration, surgical invasiveness, hematocrit, weight, and age. The random forest model exhibited AUC = 0.85 (95% confidence interval 0.80-0.90). The difference between the classification tree and random forest AUCs was nonsignificant at the validation cohort size of 205 patients (P = 0.1551). This investigation produced tree-based machine-learning models of blood transfusion risk after ASD surgery. The random forest model offered very good predictive capability as measured by AUC. Our single classification tree model offered superior ease of implementation, but a lower AUC as compared to the random forest approach, although this difference was not statistically significant at the size of our validation cohort. Clinicians may choose to implement either of these models to predict blood transfusion among their patients. Furthermore, policy makers may use these models on a population-based level to assess predicted transfusion rates after ASD surgery. 3.

Prevalence and predictors of blood transfusion after pediatric kidney transplantation.

Blood transfusion after kidney transplant carries a risk of sensitization to the graft as well as blood borne infections. The aim of this study was to describe the prevalence of blood transfusions in pediatric recipients of kidney transplants and to determine the factors associated with transfusions during the perioperative period. Additionally, to describe the changes in hemoglobin levels during the first 12months following transplant. A retrospective, single center analysis using data collected prospectively between 2010 and 2017. Red blood cell transfusion within the first week after transplant and anemia at 3months were used as outcomes. Multivariate analysis was performed on significant variates with results described according to odds ratio (OR) and interquartile range (IQR). Transfusions were given after 21 of 42 (50%) transplants in recipients aged between 1 and 17years (median 14years). Age, height, weight, and pre-transplant hemoglobin predicted transfusion in univariate analyses. Regression analysis identified pre-transplant hemoglobin as an independent factor (OR 0.85, IQR 0.73-0.98; p = 0.02). Anemia was present at 3months after 15 (36%) transplants. Anemia at 3months was associated with older and larger recipients, lower pre-transplant hemoglobin, and lower estimated glomerular filtration rate (eGFR) on univariate analysis. Logistic regression analysis identified eGFR at 3months as the only independent predictor of anemia at 3months (OR 0.93, IQR 0.87-0.99; p = 0.04). Transfusions are prevalent in the perioperative period after pediatric kidney transplantation. Lower pre-transplant hemoglobin increases the risk of transfusion. Graft function predicts hemoglobin levels at 3months.

Optimizing the Risk Assessment in Upper Gastrointestinal Bleeding: Comparison of 5 Scores Predicting 7 Outcomes

Introduction: Although different scores have been suggested to predict outcomes in the setting of upper gastrointestinal bleeding (UGIB), few comparative studies between simplified versions of older scores and recent scores have been published. We aimed to evaluate the accuracy of pre- (PreRS) and postendoscopic Rockall scores (PostRS), the Glasgow-Blatchford score (GBS) and its simplified version (sGBS), as well as the AIMS65 score in predicting different clinical outcomes. Methods: In this retrospective study, PreRS, PostRS, GBS, sGBS, and AIMS65 score were calculated, and then, areas under the receiver operating characteristic curve were used to evaluate the performance of each score to predict blood transfusion, endoscopic therapy, surgery, admission to intensive/intermediate care unit, length of hospital stay, as well as 30-day rebleeding or mortality. Results: PreRS, PostRS, GBS, and sGBS were calculated for all the 433 included patients, but AIMS65 calculation was only possible for 315 patients. Only the PreRS and PostRS were able to fairly predict 30-day mortality. The GBS and sGBS were good in predicting blood transfusion and reasonable in predicting surgery. None of the studied scores were good in predicting the need for endoscopic therapy, admission to intensive/intermediate care unit, length of hospital stay, and 30-day rebleeding. Conclusions: Owing to the identified limitations, none of the 5 studied scores could be singly used to predict all the clinically relevant outcomes in the setting of UGIB. The sGBS was as precise as the GBS in predicting blood transfusion and surgery. The PreRS and PostRS were the only scores that could predict 30-day mortality. An algorithm using the PreRS and the sGBS as an initial approach to patients with UGIB is presented and suggested.

Spectrum of Diseases/conditions Exhibiting Hemostatic Abnormalities in Patients Admitted to a Medical Intensive Care Unit of a Tertiary Care Hospital.

Background and Aims:In a medical intensive care unit (MICU), many patients develop hemostatic abnormalities, ranging from abnormal clotting tests to frank bleeding. The aim of this study was to assess the etiology of diseases that present with bleeding, its common bleeding manifestations, incidence, MICU stay, mortality, and transfusion requirements in an Indian setup and also to assess if the Acute Physiology and Chronic Health Evaluation II (APACHE II) score can be used as a predictor for blood transfusion requirements.Materials and Methods:Between July 2013 and August 2014, 200 patients with clinically significant bleeding admitted in the MICU were prospectively evaluated. Detailed history, examination, laboratory investigations, APACHE II score, and requirement of blood products were also noted. The endpoints were discharge or death.Results:The spectrum of diseases that presented with bleeding was 47 patients with malaria (23.5%) followed by 36 acute undifferentiated febrile illness (18.0%), 33 dengue (16.5%), 30 leptospirosis (15.0%), 31 acute fulminant hepatitis (15.5%), 14 sepsis (7.0%), and the rest nine miscellaneous causes. The most common bleeding manifestation observed was hematuria in 62/200 (31%). Among the patients studied, 126 expired (63%) and 74 survived (37%). Of the 200 patients, 48/200 (24%) received packed cells, 78/200 (39%) fresh frozen plasma, and 82/200 (41%) platelets.Conclusions:Tropical diseases formed the majority of admissions with bleeding manifestations. Thrombocytopenia is an important marker to predict mortality and also has a significant association with MICU stay. APACHE II score was found to be a good predictor of blood transfusion requirements.

Thromboelastometry Velocity Curve Predicts Blood Product Transfusion and Mortality Within the First 24 Hours in Severely Injured Trauma Patients

SESSION TITLE: Hematology/Oncology in the ICU SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 30, 2017 at 04:30 PM - 05:30 PM PURPOSE: The processes leading to uncontrolled bleeding after trauma are complex and heterogeneous. Thrombin generation (TG) is pivotal for an adequate hemostatic response but burdensome to assess in emergency settings. Instead, thromboelastometry (TEM), is an increasingly used point of care test for trauma patients care. TEM estimates the first derivative of the clot growth velocity curve (V-curve), which has a remarkable similarity with the endogenous thrombin potential trace and is highly correlated to TG determination by thrombin/antithrombin complex. TEM V-curve describes the maximum speed of clot formation (MaxV), the time to reach MaxV (MaxV-t) and the area under the curve (AUC). The study objective is to evaluate whether the TEM V-curve parameters (MaxV, MaxV-t, and AUC) can predict blood transfusion and mortality in the first 24h post-injury in adult trauma patients. METHODS: Retrospective cohort study of severely injured patients admitted to a Level I Trauma Center. Severity was defined as any abbreviated Injury Score (AIS) >2. Demographic data including mortality, conventional coagulation tests, rotational thromboelastometry on admission, and the total amount of blood products transfused in the first 24h were collected. With a linear regression model, we examined the effect of the V-curve parameters and the total number of blood products in 24h, adjusting for systolic pressure (SBP), temperature, injury severity score (ISS), base excess (BE), hemoglobin(HB), INR, fibrinogen, aPTT, and platelets levels. With a logistic regression model, we assessed the effect of V-curve parameters in 24h mortality, adjusting for age, AIS head, ISS, and BE. RESULTS: 550 patients were included with median ISS 19 and a median age of 43 years. The maximum speed of clot formation (MaxV) was associated with the number of units of blood product transfused in 24h of injury; for every unit decrease in MaxV (mm/min) there was an average increase of 0.7U transfused in 24h (95%CI 0.29-1.13, p= <0.0001) after adjusting for SBP, temperature, ISS, BE, hemoglobin, INR, fibrinogen, aPTT, platelets levels at admission, and the other V-curve parameters (MaxV-t, AUC). Other parameters affecting 24h blood transfusion were SBP (p= <0.0001), AUC (p= 0.037), BE (p= <0.0001). Time to reach MaxV (MaxV-t) not associated with blood transfusion. In a logistic regression model, MaxV was was associated with 24h mortality (OR 1.3, 95%CI 1.12-1.51, p= 0.0005) after adjusting for age, AIS head, ISS, and BE. Also, age(p= 0.0068), traumatic brain injury(p= 0.0027), and BE(p= 0.0033) were associated with 24h mortality. CONCLUSIONS: Our study is among the first to demonstrate an association between the TEM V-curve and clinical outcomes in trauma. Reductions in MaxV were associated with increased transfusion requirements and mortality in the initial 24h following injury, adding to the understanding of early trauma coagulopathy, that the velocity of clot growth rather than the total amount of thrombin impacts the clinical consequences significantly. CLINICAL IMPLICATIONS: TEM V-curve parameters evaluate the hemostatic potential, understanding the thrombin generation and clot formation dynamics in trauma patients with significant hemorrhage are crucial for developing adequate hemostatic strategies. DISCLOSURE: The following authors have nothing to disclose: Johana Gomez Builes, Sandro Rizoli, Andrew Baker No Product/Research Disclosure Information

Prediction of massive blood transfusion in battlefield trauma: Development and validation of the Military Acute Severe Haemorrhage (MASH) score

BackgroundThe predominant cause of preventable trauma death is bleeding, and many of these patients need resuscitation with massive blood transfusion. In resource-constrained environments, early recognition of such patients can improve planning and reduce wastage of blood products. No existing decision rule is sufficiently reliable to predict those patients requiring massive blood transfusion. This study aims to produce a decision rule for use on arrival at hospital for patients sustaining battlefield trauma. MethodsA retrospective database analysis was undertaken using the UK Joint Theatre Trauma Registry to provide a derivation and validation dataset. Regression analysis of potential predictive factors was performed. Predictive factors were analysed through multi-logistic regression analysis to build predictive models; sensitivity and specificity of these models was assessed, and the best fit models were analysed in the validation dataset. ResultsA decision rule was produced using a combination of injury pattern, clinical observations and pre-hospital data. The proposed rule, using a score of 3 or greater, demonstrated a sensitivity of 82.7% and a specificity of 88.8% for prediction of massive blood transfusion, with an AUROC of 0.93 (95% CI 0.91–0.95). ConclusionsWe have produced a decision tool with improved accuracy compared to any previously described tools that can be used to predict blood transfusion requirements in the military deployed hospital environment.

Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital

BackgroundBlood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol.Methods112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused.Results22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) <2 kg/m2 (p = 0.021), % total burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count <4000 or >12,000/μL (p = 0.05).ConclusionPre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.