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Coronary artery disease
ORIGINAL ARTICLE
A prospective observational cohort study to identify the causes of anaemia and association with outcome in cardiac surgical patients Matthew Hung,1 Erik Ortmann,1 Martin Besser,2 Pedro Martin-Cabrera,2 Toby Richards,3 Marcus Ghosh,1 Fiona Bottrill,4 Timothy Collier,5 Andrew A Klein1 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ heartjnl-2014-305856) 1
Department of Anaesthesia, Papworth Hospital, Cambridge, UK 2 Department of Haematology, Addenbrookes Hospital, Cambridge, UK 3 Division of Surgery and Interventional Science, University College London, London, UK. 4 Department of Research and Development, Papworth Hospital, Cambridge, UK 5 Department of Statistics, London School of Hygiene and Tropical Medicine, London, UK Correspondence to Dr A Klein, Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge CB23 3RE, UK; [email protected] Received 17 March 2014 Revised 13 August 2014 Accepted 25 August 2014 Published Online First 12 September 2014
ABSTRACT Objectives Preoperative anaemia is associated with increased morbidity and mortality. We sought to determine the relative frequencies of the different causes of anaemia including absolute and functional iron deficiency, and the association of different haematological parameters, including plasma hepcidin, a key protein responsible for iron regulation, with outcomes after cardiac surgery. Methods Prospective observational study between January 2012 and 2013; 200 anaemic cardiac surgical patients were recruited and 165 were studied. Detailed blood and bone marrow analysis was performed. Primary outcome was days alive and out of hospital. Results Mean (SD) haemoglobin (Hb) was 102 (8) g/L for women and 112 (11) g/L for men. Regarding outcomes, 137 (83%) patients were transfused at least one unit of red blood cells; 30-day mortality was 1.8% (three patients). Functional iron deficiency was diagnosed in 78 patients (47%). Plasma hepcidin concentration was the only haematological variable associated with outcome, with mean days alive and out of hospital 2.7 (95% CI 0.4 to 5.1) days less if hepcidin ≥20 ng/mL compared with
Coronary artery disease
ORIGINAL ARTICLE
A prospective observational cohort study to identify the causes of anaemia and association with outcome in cardiac surgical patients Matthew Hung,1 Erik Ortmann,1 Martin Besser,2 Pedro Martin-Cabrera,2 Toby Richards,3 Marcus Ghosh,1 Fiona Bottrill,4 Timothy Collier,5 Andrew A Klein1 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ heartjnl-2014-305856) 1
Department of Anaesthesia, Papworth Hospital, Cambridge, UK 2 Department of Haematology, Addenbrookes Hospital, Cambridge, UK 3 Division of Surgery and Interventional Science, University College London, London, UK. 4 Department of Research and Development, Papworth Hospital, Cambridge, UK 5 Department of Statistics, London School of Hygiene and Tropical Medicine, London, UK Correspondence to Dr A Klein, Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge CB23 3RE, UK; [email protected] Received 17 March 2014 Revised 13 August 2014 Accepted 25 August 2014 Published Online First 12 September 2014
ABSTRACT Objectives Preoperative anaemia is associated with increased morbidity and mortality. We sought to determine the relative frequencies of the different causes of anaemia including absolute and functional iron deficiency, and the association of different haematological parameters, including plasma hepcidin, a key protein responsible for iron regulation, with outcomes after cardiac surgery. Methods Prospective observational study between January 2012 and 2013; 200 anaemic cardiac surgical patients were recruited and 165 were studied. Detailed blood and bone marrow analysis was performed. Primary outcome was days alive and out of hospital. Results Mean (SD) haemoglobin (Hb) was 102 (8) g/L for women and 112 (11) g/L for men. Regarding outcomes, 137 (83%) patients were transfused at least one unit of red blood cells; 30-day mortality was 1.8% (three patients). Functional iron deficiency was diagnosed in 78 patients (47%). Plasma hepcidin concentration was the only haematological variable associated with outcome, with mean days alive and out of hospital 2.7 (95% CI 0.4 to 5.1) days less if hepcidin ≥20 ng/mL compared with
