2018/11/13 · circulation 2007; 116: 2544-2552 ,7=@; a56>82:@9
TRANSCRIPT
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N Engl J Med 2018; 379: 1224-33.
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Background
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Circulation 2008; 117: 478-84.
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Rodds ratio, 1.8; 95% CI, 1.2 to 2.7ST� .PHILDKF��6B@
propensity-score matchingR-'C�AS<+��
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Can J Anaesth 2013; 60: 168-75.
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Circulation 2007; 116: 2544-2552
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��A���)���)�$�BAadjusted odds ratio, 3.38; 95% CI, 2.60 to 4.40B#$5<?;A����) ��)!'�BAadjusted odds ratio, 3.35; 95% CI, 2.68 to 4.35B
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Circulation 2007; 116: 2544-2552
�Secondary outcome����%�������4.25&�30���%adjusted odds ratio, 6.69; 95% CI, 3.66 to 15.1; P<0.0001&31��1%adjusted odds ratio, 2.59; 95% CI, 1.68 to 4.18; P<0.0001&>1%adjusted odds ratio, 1.32; 95% CI, 1.08 to 1.64; P=0.003&
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N Engl J Med 2015; 372: 977-1008.
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Background• ����8*'�����2��WD@8�,6��1)(.'"��#0"�%�#8�!,6TRICS� &8'+73/2 &2limitation8��,6-4' �(�$5�/��
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_11.4% vs. 12.5%, odds ratio, 0.90;95% CI, 0.76 to 1.07`
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N Engl J Med 2018; 379: 1224-33.
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Methods
Study design
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PICOPatient �.�1C�?B�&���HEuroSCORE�≧6I
A"�FEDC�@B��H18!��AI�*Intervention 6/���KHb < 7.5g/dL H1�;1�IComparison 6/: 8)KHb < 9.5g/dL H1�;1�ICUI
Hb < 8.5g/dL H1�:ICU# IOutcome <Primary outcome>
1�6G��A;"�;�'��;,��;7�C�>�4%$-�A2�outcome
<Secondary outcome=• Expanded secondary composite outcome: Primary outcomeJ1�6G��AER�5;��9;��+/0��1A2�outcome• composite outcomeA�3(H1�6G��I
Inclusion criteria• 18,��• ��!@b4WY!E'Gb�U`��• G�EuroSCORE�≧6• �%T _aZS`
Ø EuroSCORE�scale 0�47[fecTPS<R!E'G�^-�gfdTPSV\b:�X`O8h
�QR#�RCOPDR!E� C5$R;>�7+BN�RL!G(�RF/CrR. #!D0RK6]G�1&R���3!6R��+BR)I^!=*�R@PF�6R?"RCABG�2��RAJ� C'GR*���M9H
Eur J Cardiothorac Surg 1999; 16: 9-13.
Exclusion criteria• "�$�5(24-'��• "�$�5��)*��• !�"#�89?:=6<;.��),'*��• ���5(3��• VAD��/*1+(/�#5(3��• ��%���/��@��� �/&3 �0<>7;�/�.�����5(3A
InterventionIntervention? Control?
strategy KD�S KDU�S
JD7KDR� Hb < 7.5g/dL |F�VF%} Hb < 9.5g/dL |F�VF%ICU}Hb < 8.5g/dL |F%UICU;3}
Hb6� !dZcjVF�V�"'A�9�{�{%VICU#�1V1, 2, 3, 5, 7, 9, 11/<
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Statistical analysis• ARHOA>DV���85%T.�KSBR3%845�U���,1:primary outcome9�46:ARHOA>D+
• Per-protocol*�• .�KSBRV��,18�:3%T0.025��αPJOU• -�Odds�;��:/$7-�V�23��3&�#3�):%03��:'"�3?P=EFR?N=MRC3IL@QGR3���(
• ��VKaplan-Meier curves3log-rank test7� • *�;R statistical package version 3.4.3<�!
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Subgroup analyses
Results
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per-protocol�4860�
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96%
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����� vs.������• �� $��� �• ��� 72�• EuroSCORE�7.9 vs. 7.8• ��Hb 13.1 vs. 13.1g/dL• ���Hb 9.4 vs. 10.2g/dL• ����CABG!# 25.6% vs. 26.5%Valve!# 28.9% vs. 29.5%CABG+valve 19.1% vs. 19.4%
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Primary outcomes
• !�#�($#�*�� )'402/2317�.17.4%/ vs. 402/2347�.17.4%/.Odds Ratio, 1.02; 95% CI, 0.87 to 1.18/
<Primary outcome>��6-���+%���%����%��%"�,�&� �����+��outcome
Secondary outcomes
• ���� �����
���141/2291��6.2%�vs. ��149/2318��6.4%��Odds Ratio, 0.95; 95% CI, 0.75 to 1.21�
• ����� ����"���!�1015/2318�%43.8%& vs. 1006/2348�%42.8%&%Odds Ratio, 1.04; 95% CI, 0.93 to 1.17&
Secondary outcomes�Expanded secondary composite outcome�Primary outcome'� 6$���#ER��������������#�outcome
Subgroup analyses of the primary outcome
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Sensitivity analyses of the primary outcome
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Discussion
Finding• TRICS�;EX6g c_fh^bdTYF�4�7�W�+���X%�ea`]!P\�0WLISF<5(>5�A/YD�A/U&=OSF�%�F�,#�F25-C�F?"]�J�9*)3��M[V\primary compositeoutcomeND �THRQG
• 6g �'TFprimary composite outcomeW�KF�BFER�:F�156�7]�Zexpanded composite outcomeX�$�8.WLISF>5�A/UD�A/UX@W!��YVMRQG
H?a@�#�noqpr• H?aK?dS\lg@�d1$TifN$#��FcO�Z_Sk�<�V !Yl_SkR
• H?D0�d79M6�8d)�eQ�M6G>m�WJXZQ#�bnoqprm N[k�<�V3�Yl_SkR
PLoS One 2017; 12: e0180165.Am Heart J 2017; 185: 140-9.
Circulation 2008; 117: 478-84.J Thorac Cardiovasc Surg 2012; 144: 654-662.
Ann Thorac Surg 2013; 96: 478-85.Ann Thorac Surg 2003; 76: 784-92.
Circulation 2007; 116: 471-9.Can J Anaesth 2015; 62: 377-84.
• C�24eI?,K?aQ@�10��d(�+s�B.�:�+d��adOLm3Z_SkR
Ann Thorac Surg 2012; 94: 460-7.Ann Thorac Surg 2002; 74: 1180-6.Ann Thorac Surg 2006; 81: 1650-7.
Circulation 2007; 116: 2544-52.
• ��aZ_QK?d-E5��%ci^_Q-��a*/D0�%d�;mg]jZQ�&h=�P�m�WJX[�<�V3�Yl_SkR
Transfusion 2018; 58: 804-15.`eQK?cikH?dA'Vnoqprm"�[kUt
P � �#=/318���7��
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?AD>��%��.@CEB��Ann Thorac Surg 2013; 96: 478-85.
�$�"!�-#���7(��4+;Fodds ratio, 3.45; 95% CI, 2.78 to 4.28G
1,1*27��5�)8&"�'"69: �0<;
• D<[G<^OWfa=�^."Pc`J"!��B]K�UZOe�9�Q� TfZOeN
• D<@-�^46I3�5^&�_M�I3C;g�RFSUM!�\hikjlg JVe�9�Q0�TfZOeN
PLoS One 2017; 12: e0180165.Am Heart J 2017; 185: 140-9.
Circulation 2008; 117: 478-84.J Thorac Cardiovasc Surg 2012; 144: 654-662.
Ann Thorac Surg 2013; 96: 478-85.Ann Thorac Surg 2003; 76: 784-92.
Circulation 2007; 116: 471-9.Can J Anaesth 2015; 62: 377-84.
• ?�/1_E<)G<[M=�10��^%�(m�>+�7�(^��[^KHg0UZRXN
Ann Thorac Surg 2012; 94: 460-7.Ann Thorac Surg 2002; 74: 1180-6.Ann Thorac Surg 2006; 81: 1650-7.
Circulation 2007; 116: 2544-52.
• ��[UZMG<^*A2��#]cYZM*��[',@-�#^�8gaXdUM�$b:�L�g�RFSV�9�Q0�TfZOeN
Transfusion 2018; 58: 804-15.
D</G<[=�!�hikjl
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• �-�0�G�5#H�G&(D�.@C;A:Ann Thorac Surg 2014; 98: 1274-80.
Transfusion 2013; 53: 1688-97.
• �5G�"��FH�89��3��*$�9�;'�)!% �9�5�4G�290���90�,�9�� +6�>�ILK:
Transfusion 2013; 53: 1688-97.J Thorac Cardiovasc Surg 2001; 122: 278-86.J Thorac Cardiovasc Surg 2014; 147: 1013-8.
• �5F<?K1/G�7H�J=DEBC;E;:
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J Thorac Cardiovasc Surg 2015; 150: 1322-8
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N Engl J Med 2017; 377: 2133-44.
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