Associations between non-anaemic iron deficiency and outcomes following elective cardiac surgery (IDOCS): a prospective cohort study.

Autor:	Miles LF; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia. Electronic address: lachlan.miles@unimelb.edu.au., Pac Soo V; Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Methods and Implementation Support for Clinical and Health research Hub, The University of Melbourne, Melbourne, VIC, Australia., Braat S; Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Methods and Implementation Support for Clinical and Health research Hub, The University of Melbourne, Melbourne, VIC, Australia., Bade-Boon J; Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia., Heritier S; Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia., Klein AA; Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK., Myles PS; Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, VIC Australia., Richards T; Division of Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, WA, Australia., Symons J; Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, VIC Australia., Burbury KL; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Division of Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia., Story DA; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia.
Jazyk:	angličtina
Zdroj:	The Lancet. Haematology [Lancet Haematol] 2022 Jul; Vol. 9 (7), pp. e514-e522.
DOI:	10.1016/S2352-3026(22)00142-9
Abstrakt:	Background: One in two adults undergoing cardiac surgery are iron deficient, best practice guidelines and consensus statements recommend routine investigation and treatment of iron deficiency before elective cardiac surgery, even in the absence of anaemia; however, it is not clear if non-anaemic iron deficiency is associated with worse outcomes in this patient population. We hypothesised that iron deficiency would be associated with worse postoperative outcomes than an iron replete state in adults without anaemia undergoing elective cardiac surgery. Methods: We performed a prospective, cohort study at two hospitals in Australia. We recruited adults (ie, people 18 years and older) undergoing elective cardiac surgery without anaemia (defined as a haemoglobin of less than 130 g/L for men and less than 120 g/L for women), concomitant haemoglobinopathy, bone marrow pathology, haemochromatosis, or end-stage renal failure requiring dialysis. Participants were stratified as iron deficient or iron replete on the basis of preoperative testing. Iron deficiency was defined as a serum ferritin of less than 100 μg/L or 100-300 μg/L if transferrin saturation was less than 20% or C-reactive protein was more than 5 mg/L. The primary endpoint was days alive and at home at postoperative day 30. The primary analysis included all patients with data available for the primary endpoint and was adjusted for risk measured using EuroSCORE-II and body surface area. The study was prospectively registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12618000185268. Findings: We conducted the study between Feb 21, 2018, and May 7, 2021. We assessed 1171 patients for eligibility and 691 were ineligible; therefore, we enrolled and followed up 480 participants. 240 (50%) were iron deficient and 240 (50%) were iron replete, 95 (20%) were women, 385 (80%) were men, and 453 (94%) were White. Complete data was available for 479 individuals (240 in the iron deficient group and 239 in the iron replete group) for the primary endpoint. The iron deficient group had a median of 22·87 days (IQR 20·65 to 24·06) alive and at home at postoperative day 30, and the iron replete group had a median of 23·18 days (IQR 20·69 to 24·70). The unadjusted difference in medians between the groups was -0·18 days (95% CI -0·73 to 0·36; p=0·51) and the adjusted difference in medians between the groups was -0·11 days (95% CI -0·66 to 0·45; p=0·70). Interpretation: In non-anaemic adults undergoing elective cardiac surgery, our findings suggest that patients with iron deficiency do not have a reduction in days alive and at home at postoperative day 30 compared with patients who have a normal iron status. Routine preoperative investigation for iron deficiency in patients without anaemia undergoing elective cardiac surgery using the definitions we tested might be low-value care. Funding: Australian and New Zealand College of Anaesthetists Foundation. Competing Interests: Declaration of interests Another study that LFM, KLB, and DAS are principal investigators for has received a grant from Vifor Pharma as part of a matched funding arrangement with the Victorian Department of Health. The institution that LFM and DAS work for has received funds and non-financial support from Edwards Lifesciences. AAK or his institution has received unrestricted educational grants, honoraria, or travel expenses from Vifor Pharma, Pharmocosmos, Nordic Pharma, Fisher & Paykel, and Masimo. PSM is a practitioner fellow of the National Health and Medical Research Council of Australia. TR or his institution have received grants, personal fees, and non-financial support from Pharmocosmos and Vifor Pharma outside of the submitted work. All other authors declare no competing interests. (Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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