title: Transfusion of 1 and 2 units of red blood cells does not increase mortality and organ failure in patients undergoing isolated coronary artery bypass grafting.
abstract: OBJECTIVE
  In cardiac surgery, the association between red blood cell (RBC) transfusion and clinical outcome is elusive. We investigated in a large cohort of patients who underwent isolated coronary artery bypass grafting (CABG) the effect of transfusion of 1-2 units of leucocyte-depleted RBCs on mortality and multiorgan failure.
  
  
  METHODS
  The investigation included all patients from July 2009 to June 2014 who underwent CABG at our institution and received no (n = 1478) or 1-2 units of RBCs (n = 1528). The primary end-point was 30-day mortality; secondary end-points were major organ dysfunction. A subgroup analysis assessed the effect of the duration of RBC storage on patient outcome. Statistical analysis was performed using propensity score (PS) adjustment.
  
  
  RESULTS
  The 30-day mortality rate was 0.3% in the RBC- group and 0.2% in the RBC+ group. Compared with the RBC- group, PS-adjusted odds ratio (OR) of 30-day mortality in the RBC+ group was 0.29 [95% confidence interval (CI): 0.06-1.50; P = 0.14]. PS-adjusted OR of a 'prolonged intensive care unit (ICU) stay' (>48 h) was significantly higher in the RBC+ group than in the RBC- group [OR 1.49 (95% CI: 1.14-1.95); P = 0.004], but major clinical complications such as low cardiac output syndrome, stroke, haemofiltration, wound infection and prolonged mechanical ventilator support (>24 h) did not differ significantly between groups. Duration of blood storage was not independently associated with clinical outcome.
  
  
  CONCLUSIONS
  Our data do not indicate a transfusion-related increase in mortality and multiorgan failure in patients undergoing isolated CABG.
authors.affiliation: Institute for Anesthesiology, Heart and Diabetes Center, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany akoster@hdz-nrw.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
authors.affiliation: Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Knabbe
authors.affiliation: Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Diekmann
authors.affiliation: Institute for Anesthesiology, Heart and Diabetes Center, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schirmer
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gummert
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology*; D012189:Retrospective Studies
keywords: Coronary artery bypass grafting; Leucocyte depletion; Mortality; Red blood cell storage; Transfusion