Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial.

Ren Liao; Jin Liu; Wei Zhang; Hong Zheng; Zhaoqiong Zhu; Haorui Sun; Zhangsheng YU; Huiqun Jia; Yanyuan Sun; Li Qin; Wenli YU; Zhen Luo; Yanqing Chen; Kexian Zhang; Lulu MA; Hui Yang; Hong WU; Limin Liu; Fang Yuan; Hongwei XU; Jianwen Zhang; Lei Zhang; Dexing Liu; Han Huang

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Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial.

Author: Ren LIAO ¹ ; Jin LIU ¹ ; Wei ZHANG ² ; Hong ZHENG ³ ; Zhaoqiong ZHU ⁴ ; Haorui SUN ⁵ ; Zhangsheng YU ⁶ ; Huiqun JIA ⁷ ; Yanyuan SUN ⁸ ; Li QIN ⁹ ; Wenli YU ¹⁰ ; Zhen LUO ¹ ; Yanqing CHEN ¹¹ ; Kexian ZHANG ¹² ; Lulu MA ¹³ ; Hui YANG ¹⁴ ; Hong WU ¹⁵ ; Limin LIU ¹⁶ ; Fang YUAN ¹⁷ ; Hongwei XU ¹ ; Jianwen ZHANG ² ; Lei ZHANG ³ ; Dexing LIU ⁴ ; Han HUANG ¹⁸
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1. Department of Anesthesiology, Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
2. Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China.
3. Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University,Urumqi, Xinjiang 830054, China.
4. Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China.
5. Department of Anesthesiology, Beijing Friendship Hospital of Capital Medical University, Beijing 100069, China.
6. Department of Bioinformatics and Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China.
7. Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiangzhuang, Hebei 050019, China.
8. Department of Anesthesiology, Xijing Hospital of the Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
9. Department of Transfusion, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
10. Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, China.
11. Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, Fujian 350001, China.
12. Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan 610041, China.
13. Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100032, China.
14. Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
15. Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
16. Department of Orthopedic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
17. Department of Anesthesiology, General Hospital Affiliated to Tianjin Medical University, Tianjin 300052, China.
18. Department of Anesthesiology and Translational Neuroscience Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
Publication Type:Journal Article
MeSH: Humans; Adult; Postoperative Complications; Erythrocyte Transfusion/adverse effects*; Blood Transfusion; Hospitals; Hemoglobins/analysis*
From: Chinese Medical Journal 2023;136(23):2857-2866
CountryChina
Language:English
Abstract: BACKGROUND:Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.
METHODS:Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).
RESULTS:We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.
CONCLUSION:The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.
TRIAL REGISTRATION:ClinicalTrials.gov, NCT01597232.