Red Blood Cell Transfusion as a Predictor of Outcome after Cardiac Surgery in Neonates and Young Infants Público

Abstract

Introduction: Little is known about the adverse outcomes associated with red blood cell (RBC) transfusion in neonates and young infants undergoing cardiac surgery. The goal of this paper was to examine associations between RBC transfusion, both intra-operatively and post-operatively, and adverse outcomes in this patient population. We sought to adjust for surgical risk scores and implement a standardized measure of RBC volume per kilogram for each patient. We then extend these results to develop a clinical tool that predicts patient complication risk post-surgery.

Methods: We retrospectively analyzed a cohort of 605 patients (666 surgeries in total) aged 6 months or less who underwent cardiac bypass surgery. Clinical parameters included age, weight, risk adjustment for congenital heart surgery (RACHS1 and STAT) scores, intensive care unit length of stay (ICU LOS), RBC volume transfused intra-operatively, RBC volume transfused 24 hours post-operatively, cross-clamp time, and cardiopulmonary bypass (CPB) time. Risk-adjusted logistic regression and lognormal regression were used to assess the influence of RBC transfusion on complication risk and LOS, respectively. Finally, we trained and tested 3 models (random forest, decision tree, and logistic regression) for predicting patient complication risk post-surgery. We generated the receiver operating characteristics (ROC) curve for each model and calculated area under the curve (AUC) as a performance metric.

Results: In our cohort, we observed 137 (20.6%) complications. Patients that were transfused post-operatively had a significantly higher risk of post-surgery complications (95% C.I. for OR, [3.06,7]). Both intra-operative and post-operative standardized RBC transfusion volumes were associated with higher complication risk, after controlling for patient age and surgery risk scores (p<0.001 for both). We found similar results when considering our secondary outcome, ICU LOS. Both intra-operative (p<0.001) and post-operative (p=0.004) standardized RBC transfusion volumes were associated with increased ICU LOS. The random forest model had the highest predictive accuracy with an AUC of 0.718.

Discussion: Our findings suggest that this younger population of pediatric cardiac surgical patients is particularly volume-sensitive to RBC transfusion, even after controlling for variables such as surgery risk. Our predictive model may assist in identifying patients that are high-risk for complication immediately following surgery.

Table of Contents

1. Introduction..................................................................1 1.1 Overview......................................................1

1.2 Problem Statement........................................1

1.3 Purpose Statement.........................................2

1.4 Significance Statement...................................2

2. Background...................................................................3

2.1 RBC Transfusion Overview...............................3

2.2 RBC Transfusion in Pediatric Cardiac Surgery.....3

2.3 Statistical Considerations.................................5

2.4 Predictive Modeling.........................................6

3. Methodology..................................................................7

3.1 Study Design..................................................7

3.2 Data Collection...............................................8 3.3 Statistical Analysis..........................................9 4. Results..........................................................................10 4.1 Univariate Analysis.........................................10

4.2 Multivariate Analysis.......................................11

4.3 Predictive Modeling.........................................13 5. Discussion.....................................................................14

5.1 Introduction & Implications..............................14

5.2 Recommendations..........................................15 References..........................................................................17

Appendix: Tables & Figures...................................................20

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Biology, Biostatistics Health Sciences, Medicine and Surgery
Palabra Clave	Cardiac Surgery Transfusion
Committee Chair / Thesis Advisor	Leong, Traci, Emory University
Committee Members	Lyles, Robert, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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