Nonanemic Iron Deficiency in Cardiac Surgery: A Retrospective Observational Study.

Autor: Horwood CGA; University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK. Electronic address: charliehorwood@gmail.com., Patel ND; University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK., Walker JD; Ysbyty Gwynedd, Betsi Cadwalader University Health Board, Bangor, Wales, UK., Evans CR; University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2024 Sep; Vol. 38 (9), pp. 1899-1906. Date of Electronic Publication: 2024 May 31.
DOI: 10.1053/j.jvca.2024.05.039
Abstrakt: Objectives: Anemia and iron deficiency in patients having cardiac surgery increases their perioperative risk. Nonanemic iron deficiency (NAID) in this group is less well-described. We aimed to investigate the incidence and outcomes of patients with NAID undergoing cardiac surgery.
Design: Retrospective observational study.
Setting: A single, tertiary referral center.
Participants: Adult patients who were preassessed and underwent cardiac surgery during the study period had data collected. We enrolled 537 patients enrolled and divided them into 4 groups according to hemoglobin and ferritin: NAID, nonanemic iron replete, iron-deficiency anemia (IDA), and non-iron-deficiency anemia.
Interventions: This study was not interventional, but assessed the impact of anemia and iron deficiency on patient outcomes.
Measurements and Main Results: The primary outcome was the incidence of NAID. Secondary outcomes included the number of patients who became anemic awaiting surgery, allogeneic transfusion burden, length of stay, postoperative complications, and death. 179 of 537 patients (33.3%) had NAID. Seventeen patients (9.5%) became anemic in the NAID group compared with 7 (3.3%) in the nonanemic iron replete group while awaiting for surgery (p = 0.02). Patients with NAID were more likely to receive allogeneic transfusions (33% vs 23%; p = 0.04) and had poorer recovery of hemoglobin at follow-up (13.2 ± 1.46 g/dL vs 13.9 ± 1.46 g/dL; p < 0.001).
Conclusions: NAID is common and can lead to progression to anemia and increased transfusion. Iron replacement should be considered in patients with NAID in the preoperative setting. A prospective interventional trial is required to demonstrate the benefit of being iron replete.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr Caroline Evans receives honoraria for speaking roles supporting the role of intravenous iron in PBM from Pfizer and Pharmacosmos. Dr Evans is also the anemia lead for the Welsh Blood Service and co-author of the Centre for Perioperative Care Guidance on Anaemia and the British Society of Haematoiogy Guidelines on Preoperative Anaemia.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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