背景:探讨术前血清白蛋白低与全关节置换术(TJA)患者围手术期输血的关系。
方法:我们在2017年1月1日至2022年1月1日期间从我院招募了2,772名TJA患者。从电子病历中提取临床数据,包括病人ID,性别,BMI(身体质量指数),年龄,和诊断。构建受试者工作特征曲线以建立血清白蛋白水平分类的阈值。以术前血清白蛋白为因变量,以围手术期输血相关因素为协变量,进行倾向评分匹配(PSM)。包括BMI等级,年龄等级,性别,诊断,高血压,糖尿病,冠心病,慢性阻塞性肺疾病,慢性支气管炎,脑梗塞,过去12个月内的大型手术,肾功能衰竭,癌症,抑郁症,使用皮质类固醇,吸烟,饮酒,和血型。低血清白蛋白组与正常白蛋白组以1:2的比例匹配,采用0.2的卡尺值。采用二元logistic回归分析结果。
结果:在0.601的曲线下发现,表明截断值为37.3g/L。在PSM之后,低血清(<37.3g/L)白蛋白组892例配对成功,血清白蛋白正常(≥37.3g/L)组1401例匹配。TJA患者的二元logistic回归分析显示,白蛋白OR为0.911,95CI为0.888~0.935,P<0.001。相对于术前血清白蛋白正常组,低血清白蛋白组TJA患者的围手术期输血率增加了1.83倍(95%CI1.50-2.23,P<0.001)。与正常血清白蛋白组相比,血清白蛋白水平为30-37.3g/L的TJA患者围手术期输血率,25-30g/L,和≤25g/L增加1.63(95%CI1.37-1.99,P<0.001),5.4(95%CI3.08-9.50,P<0.001),和6.43倍(95%CI1.80-22.96,P=0.004),分别。
结论:在TJA患者中,术前低血清白蛋白水平与围手术期输血风险增加相关.此外,据观察,术前血清白蛋白水平越低,围手术期输血的风险越高。
背景:2021年12月28日,中国临床试验注册中心,ChiCRT2100054844。
BACKGROUND: To investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA).
METHODS: We enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes.
RESULTS: An under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888-0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50-2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30-37.3 g/L, 25-30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37-1.99, P < 0.001), 5.4 (95% CI 3.08-9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively.
CONCLUSIONS: In TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion.
BACKGROUND: 28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844.