| 1. |
- Bjursten, Henrik, et al.
(författare)
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Increased long-term mortality with plasma transfusion after coronary artery bypass surgery.
- 2013
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 39:3, s. 437-444
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Patients undergoing cardiac surgery often require transfusions of red blood cells, plasma and platelets. These components differ widely in both indications for use and composition. However, from a statistical point of view there is a significant colinearity between the components. This study explores the relation between the transfusion of different blood components and long-term mortality. METHODS: A retrospective single-centre study was performed including 5,261 coronary artery bypass grafting patients, excluding patients receiving more than eight units of red blood cells, those suffering early death (7 days) and emergency cases. Patients were followed up for a period of up to 7.5 years. A broad spectrum of potential risk factors was analysed using Cox proportional hazards survival regression. Non-significant risk factors were removed by step-wise elimination, and transfusion of red blood cells, plasma and platelets was forced to remain in the model. RESULTS: The transfusion of red blood cells was not associated with decreased long-term mortality (HR = 1.007, p = 0.775), whereas the transfusion of plasma was associated with decreased long-term survival (HR = 1.060, p < 0.001), and the transfusion of platelets was associated with increased long-term survival (HR = 0.817, p = 0.011). The risk associated with transfusion of plasma was mainly attributed to patients receiving large amounts of plasma. All hazard ratios are per unit of blood product transfused. CONCLUSIONS: No association was found between the transfusion of red blood cells and mortality during the study period. However, transfusion of plasma was associated with increased mortality while transfusion of platelets was associated with decreased mortality during the study period.
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| 2. |
- Bjursten, Henrik, et al.
(författare)
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Risks Associated With the Transfusion of Various Blood Products in Aortic Valve Replacement.
- 2013
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 96:2, s. 494-499
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Tidskriftsartikel (refereegranskat)abstract
- Patients undergoing cardiac operations often require transfusions of red blood cells, plasma, and platelets. From a statistical point of view, there is a significant collinearity between the components, but they differ in indications for use and composition. This study explores the relationship between the transfusion of different blood components and long-term mortality in patients undergoing aortic valve replacement alone or combined with revascularization.
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| 3. |
- Dardashti, Alain, et al.
(författare)
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Blood transfusion after cardiac surgery: is it the patient or the transfusion that carries the risk?
- 2011
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 55, s. 952-961
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Tidskriftsartikel (refereegranskat)abstract
- Background: The transfusion of red blood cells (RBCs) after cardiac surgery has been associated with increased long-term mortality. This study reexamines this hypothesis by including pre-operative hemoglobin (Hb) levels and renal function in the analysis. Methods: A retrospective single-center study was performed including 5261 coronary artery bypass grafting (CABG) patients in a Cox proportional hazard survival analysis. Patients with more than eight RBC transfusions, early death (7 days), and emergent cases were excluded. Patients were followed for 7.5 years. Previously known risk factors were entered into the analysis together with pre-operative Hb and estimated glomerular filtration rate (eGFR). In addition, subgroups were formed based on the patients' pre-operative renal function and Hb levels. Results: When classical risk factors were entered into the analysis, transfusion of RBCs was associated with reduced long-term survival. When pre-operative eGFR and Hb was entered into the analysis, however, transfusion of RBCs did not affect survival significantly. In the subgroups, transfusion of RBCs did not have any effect on long-term survival. Conclusions: When pre-operative Hb levels and renal function are taken into account, moderate transfusions of RBC after CABG surgery do not seem to be associated with reduced long-term survival.
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| 4. |
- Dardashti, Alain, et al.
(författare)
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Erythropoietin and Protection of Renal Function in Cardiac Surgery (the EPRICS Trial).
- 2014
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Ingår i: Anesthesiology. - 1528-1175. ; 121:3, s. 582-590
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Tidskriftsartikel (refereegranskat)abstract
- To date, there are no known methods for preventing acute kidney injury after cardiac surgery. Increasing evidence suggests that erythropoietin has renal antiapoptotic and tissue protective effects. However, recent human studies have shown conflicting results. The authors aimed to study the effect of a single high-dose erythropoietin preoperatively on renal function after coronary artery bypass grafting in patients with preoperative impaired renal function.
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| 5. |
- Dardashti, Alain
(författare)
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Importance of renal function in cardiac surgery
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Acute kidney injury (AKI) is a common and serious complication after cardiothoracic surgery and is associated with increased short- and long-term mortality risk. Despite extensive studies in the field, a comprehensive understanding of this syndrome has remained elusive, partly due to divergent definitions of AKI and partly due to the limitations of available routine biomarkers to predict, prevent, and detect AKI. In recent years, much has been done to better define AKI. There is also ongoing work on finding better suited biomarkers for AKI as well as improving treatment of patients at risk or suffering from AKI. In this work we studied different aspects of renal function after cardiac surgery. The first paper shows in a retrsospective study of 5261patients, when preoperative estimated glomerular filtration (eGFR) rate by s-creatinine and preoperative hemoglobin is entered into a Cox analysis together with known traditinoal risk factors for decreased long-term survival, blood transfusion did not affect survival significantly. In the subgroups of patients with normal eGFR and hemoglobin, blood transfusions did not have any effect on longterm survival. In the second paper, incidence of AKI is evaluated in 5746 patients, defined by different measures (i.e creatinine, creatinine clearance and eGFR) and evaluated in relation to long-term mortality. The effect of renal recovery on survival was also described. The Risk, Injury, Failure, Lost and Endstage (RIFLE) system was used to stratify AKI. The study showed that estimated GFR by the modification of diet in renal disease (MDRD) formula had a more robust predictive ability for mortality and that renal recovery in general was associated with better outcome compared with those without renal recovery. The third paper describes a randomized, double-blind, placebo-controlled trial, where the effect of a single high dose erythropoeitin (EPO) preoperatively, as a protective drug against AKI after cardiac surgery, is evaluated. Seventy five patients were enrolled in the study, AKI was evaluated by the changes of s-cystatin C at the third postoperative day from baseline. No protective effect against AKI by EPO could be shown. In the fourth paper the predictive value for mortality of s-creatinine and s-cystatin C and their eGFR were evaluated at different time points in patients undergoing cardiac surgery. The prospective study included 1955 patients. Different creatinine and cystatin C eGFR equations were used in the analysis. S-Cystatin C was shown to have a stronger and earlier predictive value for mortality compred with s-creatinine, and the predictive abliltiy of cystatin C was also shown preoperatievly.
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| 6. |
- Dardashti, Alain, et al.
(författare)
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Incidence, dynamics, and prognostic value of acute kidney injury for death after cardiac surgery.
- 2014
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 1097-685X .- 0022-5223. ; 147:2, s. 800-807
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Tidskriftsartikel (refereegranskat)abstract
- This study relates long-term mortality after cardiac surgery to different methods of measuring postoperative renal function, classified according to the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. The dynamics of acute kidney injury during hospital stay were studied by comparing renal function preoperatively, at its poorest measurement, and at discharge.
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