TY - JOUR
T1 - The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery
AU - Klein, A. A.
AU - Collier, T.
AU - Yeates, J.
AU - Miles, L. F.
AU - Fletcher, S. N.
AU - Evans, C.
AU - Richards, T.
AU - on behalf of the Association of Cardiothoracic Anaesthesia and Critical Care
N1 - Funding Information:
All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: A.A.K. has received funding for research/education and/or honoraria and travel support from Pharmacosmos, Vifor Pharma, CSL Behring and Fisher and Paykel; C.E. has received honoraria and travel support from Pharmacosmos; T.R. has received funding for research/ education and/or honoraria and travel support from Pharmacosmos and Vifor Pharma. S.F. is the President of the Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC). The authors received no support from any organisation for the submitted work; and no financial relationships with any organisations that might have an interest in the submitted work in the previous three yr; and no other relationships or activities that could appear to have influenced the submitted work.
Publisher Copyright:
© 2017 The Author.
PY - 2017/9
Y1 - 2017/9
N2 - Background. A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking. We conducted a retrospective analysis of data collected from the ACTA National Audit. For the derivation dataset, we included data from 20 036 patients, which we then externally validated using a further group of 1047 patients. Methods. We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score. Results. Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients. Conclusions. The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.
AB - Background. A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking. We conducted a retrospective analysis of data collected from the ACTA National Audit. For the derivation dataset, we included data from 20 036 patients, which we then externally validated using a further group of 1047 patients. Methods. We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score. Results. Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients. Conclusions. The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.
KW - anaesthesia
KW - cardiovascular
KW - risk prediction
KW - transfusion
UR - http://www.scopus.com/inward/record.url?scp=85029807282&partnerID=8YFLogxK
U2 - 10.1093/bja/aex205
DO - 10.1093/bja/aex205
M3 - Article
C2 - 28969306
AN - SCOPUS:85029807282
SN - 0007-0912
VL - 119
SP - 394
EP - 401
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 3
ER -