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Transfusion of Red Blood Cells, Fresh Frozen Plasma, or Platelets Is Associated With Mortality and Infection After Cardiac Surgery in a Dose-Dependent Manner

Ming, Yue MMed*; Liu, Jing MMed; Zhang, Fengjiang MD, PhD*; Chen, Changwei MMed; Zhou, Li MD, PhD; Du, Lei MD, PhD; Yan, Min MD, PhD*

doi: 10.1213/ANE.0000000000004528
Blood Management: PDF Only

BACKGROUND: It is unclear whether transfusion of platelets or fresh frozen plasma, in addition to red blood cells, is associated with an increased risk of mortality and infection after cardiac surgery.

METHODS: Patients who underwent valve surgery and/or coronary artery bypass grafting from January 1, 2011 to June 30, 2017 and September 1, 2013 to June 30, 2017 at 2 centers performing cardiac surgery were included in this retrospective study. After stratifying patients based on propensity score matching, we compared rates of mortality and infection between patients who transfused red blood cells, fresh frozen plasma, or platelets with those who did not receive such transfusions. We also compared outcomes between patients who received any of the 3 blood products and patients who received no transfusions at all. Multivariable logistic regression was used to assess associations between transfusion and outcomes.

RESULTS: Of 8238 patients in this study, 109 (1.3%) died, 812 (9.9%) experienced infection, and 4937 (59.9%) received at least 1 type of blood product. Transfusion of any blood type was associated with higher rates of mortality (2.0% vs 0.18%; P < .01) and infection (13.3% vs 4.8%; P < .01). Each of the 3 blood products was independently associated with an increase in mortality per unit transfused (red blood cells, odds ratio 1.18, 95% confidence interval [CI], 1.14–1.22; fresh frozen plasma, odds ratio 1.24, 95% CI, 1.18–1.30; platelets, odds ratio 1.12, 95% CI, 1.07–1.18). Transfusing 3 units of any of the 3 blood products was associated with a dose-dependent increase in the incidence of mortality (odds ratio 1.88, 95% CI, 1.70–2.08) and infection (odds ratio 1.50, 95% CI, 1.43–1.57).

CONCLUSIONS: Transfusion of red blood cells, fresh frozen plasma, or platelets is an independent risk factor of mortality and infection, and combination of the 3 blood products is associated with adverse outcomes after cardiac surgery in a dose-dependent manner.

From the *Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China

Department of Anesthesiology and Translational Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Accepted for publication October 3, 2019.

Funding: This work was supported by the 1.3.5 Project for Disciplines of Excellence (ZY2016101), West China Hospital of Sichuan University, and the National and Zhejiang Health and Family Planning Commission (2018272998), the Second Affiliated Hospital of Zhejiang University.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Reprints will not be available from the authors.

Address correspondence to Min Yan, MD, PhD, Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University, No. 88 Jiefang Rd, Hangzhou, Zhejiang, 330100, China. Address e-mail to

© 2019 International Anesthesia Research Society
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