title: Assessment of perioperative transfusion requirement for cirrhotic patients undergoing elective hepatectomy.
abstract: BACKGROUND
  The possibility of outlining a risk profile for perioperative blood transfusion of cirrhotic patients submitted to hepatic resection can help to rationalize transfusion policy.
  
  
  METHODS
  Data from 323 hepatic resections, performed in cirrhotic patients, were reviewed. Bootstrap and a leave-one-out logistic regressions were applied to test the accuracy of available risk scores for peri-operative transfusion identified from PubMed search of the last 20 years, to refine them, and to provide internal validation for present results.
  
  
  RESULTS
  One-hundred-six patients (32.8%) required blood transfusions during either intra- and/or postoperative. The predictive accuracy of three identified risk scores was poor with the area under receiver operating characteristics (AUROC) curves <0.70 in all cases. Tumor diameter, hemoglobin and presence of coronary artery disease were confirmed, in the present cohort, as predictors of blood transfusion together with serum albumin and bilirubin. The leave-one-out logistic regression results in an AUROC of 0.80, and of 0.79 for internal validation, significantly higher than that of the three scores tested (P<0.001). A Maximal Surgical Blood Order Schedule stratification was proposed.
  
  
  CONCLUSIONS
  The risk profile for transfusion of cirrhotic patients undergoing hepatectomy can be better assessed with a model that combines already known clinical factors and hepatic function indexes.
authors.affiliation: General and Transplant Surgical Unit, Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, S. Orsola Hospital, Bologna, Italy - aleqko@libero.it.
authors.forename: A
authors.initials: A
authors.lastname: Cucchetti
authors.forename: A
authors.initials: A
authors.lastname: Siniscalchi
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: F
authors.initials: F
authors.lastname: Mazzotti
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.forename: S
authors.initials: S
authors.lastname: Faenza
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment