【罂粟摘要】术前静脉补铁与输注红细胞治疗缺铁性贫血的倾向匹配队列研究

背景：虽然术前贫血与不良围手术期结局相关，但铁替代治疗与红细胞（RBC）输注相比的益处仍不确定。我们使用国家数据库来确定术前缺铁性贫血 (IDA) 治疗的趋势，并检验术前铁治疗可能优于红细胞输注的假设。

方法：本研究是使用 TriNetX 研究网络对 2003 年至 2023 年进行的倾向匹配回顾性队列分析，其中包括术前 3 个月内诊断为 IDA 的手术患者。在匹配手术类型和合并症后，我们比较了术前接受静脉（IV）铁剂治疗但未接受红细胞治疗的术前 IDA 患者队列（n = 77,179）与接受术前红细胞治疗但未接受静脉铁剂治疗的队列（n = 77,179）。对年龄、民族、种族、性别、超重和肥胖、2型糖尿病、高脂血症、原发性高血压、心力衰竭、慢性缺血性心脏病、肿瘤、甲状腺功能减退、慢性肾病、尼古丁依赖、手术类型、 手术当天的实验室值，包括铁蛋白、转铁蛋白和血红蛋白，分为低 (<7 g/dL)、中 (7–<12 g/dL) 和高 (≥12 g/dL)，以考虑贫血情况 严重程度。主要结局是术后 30 天死亡率，次要结局是 30 天发病率、术后血红蛋白水平和术后 30 天红细胞输血情况。

结果：与红细胞输注相比，术前IV铁剂与术后死亡风险较低相关（n=2550/77，179[3.3%] vs n=4042/77，179 [5.2%];相对风险[RR]为0.63，95%置信区间[CI]为0.60-0.66），术后复合发病率风险较低。（n=14，174/77，179[18.4%] vs n=18，632/77，179[24.1%]; RR，0.76，95%CI，0.75-0.78）（在Bonferroni校正后，两个P值均为0.001）。与红细胞输注相比，静脉输注铁也与术后30天内较高的血红蛋白相关（Bonferroni校正后为10.1 ± 1.8 g/dL vs 9.4 ± 1.7 g/dL，P=0.001）和术后红细胞输血发生率降低（n=3773/77，179 [4.9%] vs n=12，629/77，179 [16.4%];相对危险度为0.30，95%置信区间为0.29-0.31）。

结论：在一项风险调整分析中，与红细胞输注相比，术前IV铁剂IDA治疗与术后30天死亡率和发病率降低、术后30天血红蛋白水平升高和术后红细胞输注减少相关。这一证据代表了改善患者预后和减少输血及其相关风险和成本的有希望的机会。

原始文献来源：

Choi,U.E.,Nicholson,R.C.,Thomas,A.J.,Crowe,E.P.,Ulatowski,J.A.,Resar,L.M.S.,Hensley,N.B.,& Frank,S.M.(2024).A Propensity-Matched Cohort Study of Intravenous Iron versus Red Cell Transfusions for Preoperative Iron-Deficiency Anemia.Anesthesia&Analgesia,139(5),969977.https://doi.org/10.1213/ANE.0000000000006974

A Propensity-Matched Cohort Study of Intravenous Iron versus Red Cell Transfusions for Preoperative Iron-Deficiency Anemia

Background: While preoperative anemia is associated with adverse perioperative outcomes,the benefits of treatment with iron replacement versus red blood cell (RBC) transfusion remain uncertain. We used a national database to establish trends in preoperative iron-deficiency anemia (IDA) treatment and to test the hypothesis that treatment with preoperative iron may be superior to RBC transfusion.

Method:This study is a propensity-matched retrospective cohort analysis from 2003 to 2023 using TriNetX Research Network, which included surgical patients diagnosed with IDA within 3 months preoperatively. After matching for surgery type and comorbidities, we compared a cohort of patients with preoperative IDA who were treated with preoperative intravenous (IV) iron but not RBCs (n = 77,179), with a cohort receiving preoperative RBCs but not IV iron (n = 77,179).Propensity-score matching was performed for age, ethnicity, race, sex, overweight and obesity,type 2 diabetes, hyperlipidemia, essential hypertension, heart failure, chronic ischemic heart disease, neoplasms, hypothyroidism, chronic kidney disease, nicotine dependence, surgery type, and lab values from the day of surgery including ferritin, transferrin, and hemoglobin split into low (<7 g/dL), medium (7–<12 g/dL), and high (≥12 g/dL) to account for anemia severity.The primary outcome was 30-day postoperative mortality with the secondary outcomes being 30-day morbidity, postoperative hemoglobin level, and 30-day postoperative RBC transfusion.

Results:Compared with RBC transfusion, preoperative IV iron was associated with lower risk of postoperative mortality (n = 2550/77,179 [3.3%] vs n = 4042/77,179 [5.2%]; relative risk [RR], 0.63, 95% confidence interval [CI], 0.60–0.66), and a lower risk of postoperative composite morbidity (n = 14,174/77,179 [18.4%] vs n = 18,632/77,179 [24.1%]; RR, 0.76, 95% CI,0.75–0.78) (both P = .001 after Bonferroni adjustment). Compared with RBC transfusion, IV iron was also associated with a higher hemoglobin in the 30-day postoperative period (10.1 ±1.8 g/dL vs 9.4 ± 1.7 g/dL, P = .001 after Bonferroni adjustment) and a reduced incidence of postoperative RBC transfusion (n = 3773/77,179 [4.9%] vs n = 12,629/77,179 [16.4%]; RR,0.30, 95% CI, 0.29–0.31).

Conclusion:In a risk-adjusted analysis, preoperative IDA treatment with IV iron compared to RBC transfusion was associated with a reduction in 30-day postoperative mortality and morbidity, a higher 30-day postoperative hemoglobin level, and reduced postoperative RBC transfusion.This evidence represents a promising opportunity to improve patient outcomes and reduce blood transfusions and their associated risk and costs. (Anesth Analg 2024;139:969–77)