/ Prof Jin Liu
Jin Liu, M.D., is the professor and chairman of Anesthesiology Department and Director of Translational Neuroscience Center at West China Hospital, Sichuan University, Chengdu, China. He is the immediate past president of Chinese Society of Anesthesiology. He received his MD degree in the Chinese Academy of Medical Sciences in 1988, trained as post-doctor at UCSF and worked as a VAP and attending anesthesiologist at SWMC in the USA from 1989-1994.
His research focuses on inhale anesthesia, perioperative blood management and development of new anesthetics. He has published 200 research papers in English and 230 papers in Chinese.
Individualized Red-cell Transfusion Strategy for Non-cardiac Surgery in Adults
Jin Liu, M.D.,
Department of Anaesthesiology, West China Hospital, Chengdu, China
It is a consensus that individualized transfusion strategy is needed.
In this multicenter trial, 1213 patients undergoing non-cardiac surgeries with hemoglobin concentration <10 g per deciliter were randomly assigned to an individualized-strategy using the West-China-Liu’s Score, a restrictive-strategy following China’s guideline, or a liberal-strategy with transfusion threshold of hemoglobin concentration < 9.5 g per deciliter. Primary outcomes were red-cell requirement and composite of in-hospital complications and mortality by day-30.
31% of patients in the individualized-strategy received red-cell transfusion, less than 62% in the restrictive-strategy (absolute risk difference, 31.92 percentage points; 97.5% confidence interval[CI] 24.42 to 39.42; odds ratio, 3.78; 97.5% CI, 2.7 to 5.3; p<0.001) and 90% in the liberal-strategy (absolute risk difference, 59.24 percentage points; 97.5% CI, 52.91 to 65.57; odds ratio, 20.06; 97.5% CI, 12.74 to 31.57; p<0.001). Average red-cell units transfused (1.58±3.51, 3.14±4.13 and 4.33±4.82, p<0.001) and hospital cost (62±47, 66±48 and 68±43 thousand Chinese Yuan, p=0.013) were individualized < restrictive < liberal group. Mortality by day-60 in the individualized-strategy (1.2%) and restrictive-strategy (0.8%) were lower than that in the liberal-strategy (4.1%, p=0.003). No differences were found for composite of in-hospital complications and mortality by day-30 and other secondary outcomes.
An individualized-strategy with the West-China-Liu’s Score is safe and cost-effective. Both individualized-strategy and restrictive-strategy reduce red-cell transfusion, hospital cost and mortality by day-60 than a liberal-strategy. An individualized-strategy further reduces red-cell transfusion and hospital cost than a restrictive-strategy.