【罂粟摘要】与非心脏手术(BIMS)后死亡率独立相关的出血：一项建立诊断标准和预后重要性的国际前瞻性队列研究
与非心脏手术(BIMS)后死亡率独立相关的出血：一项建立诊断标准和预后重要性的国际前瞻性队列研究
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
我们的目的是建立非心脏手术（BIMS）后出血与死亡率独立相关的诊断标准，定义为非心脏手术期间或30天内出血与手术后30天内死亡率独立相关，并估计术后30天死亡率中可能归因于BIMS的比例。
本研究为前瞻性队列研究，纳入标准为年龄≥45岁，2007年至2011年间在8个国家的12家学术医院接受非心脏手术住院治疗的患者。用Cox比例风险模型评估BIMS候选诊断标准与手术后30天内全因死亡率之间的调整关系。
在16079名参与者中，2.0%(315名)死亡，36.1%(5810名)符合预先定义的出血筛查标准。根据与30d死亡率的独立相关性，BIMS被确定为出血导致术后血红蛋白<70gL/1，输注≥1单位红细胞，或因此导致死亡。与非心脏手术后死亡率独立相关的出血发生率为17.3%(2782例)。BIMS患者的死亡率为5.8%(161/2782)，符合出血筛查标准但不符合BIMS标准的患者为1.3%(39/3028)，无出血的患者为1.1%(115/10269)。BIMS与死亡率相关(调整后的危险比：1.87；95%可信区间：1.42-2.47)。我们估计BIMS可能导致术后30天死亡的比例为201.1-31.9%。
与非心脏手术(BIMS)后死亡率独立相关的出血(定义为术后出血导致血红蛋白<70gL/1、输血或被判定为死亡原因)很常见，可能占非心脏手术后死亡的四分之一。
Roshanov PS, Eikelboom JW, Sessler DI, Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study establishing diagnostic criteria and prognostic importance[J].Br J Anaesth. 2021 Jan;126(1):163-171. doi: 10.1016/j.bja.2020.06.051. Epub 2020 Aug 5.
Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study establishing diagnostic criteria and prognostic importance
Background: We aimed to establish diagnostic criteria for bleeding independently associated with mortality after noncardiac surgery (BIMS) defined as bleeding during or within 30 days after noncardiac surgery that is independently associated with mortality within 30 days of surgery, and to estimate the proportion of 30-day postoperative mortality potentially attributable to BIMS.
Methods: This was a prospective cohort study of participants ?45 yr old having inpatient noncardiac surgery at 12 academic hospitals in eight countries between 2007 and 2011. Cox proportional hazards models evaluated the adjusted relationship between candidate diagnostic criteria for BIMS and all-cause mortality within 30 days of surgery.
Results: Of 16 079 participants, 2.0% (315) died and 36.1% (5810) met predefined screening criteria for bleeding. Based on independent association with 30-day mortality, BIMS was identified as bleeding leading to a postoperative haemoglobin<70 g L/1, transfusion of ≥1 unit of red blood cells, or that was judged to be the cause of death. Bleeding independently associated with mortality after noncardiac surgery occurred in 17.3% of patients (2782). Death occurred in 5.8% of patients with BIMS (161/2782), 1.3% (39/3028) who met bleeding screening criteria but not BIMS criteria, and 1.1% (115/10269) without bleeding. BIMS was associated with mortality (adjusted hazard ratio: 1.87; 95% confidence interval:1.42-2.47). We estimated the proportion of 30-day postoperative deaths potentially attributable to BIMS to be 20.1-31.9%.
Conclusions: Bleeding independently associated with mortality after noncardiac surgery (BIMS), defined as bleeding that leads to a postoperative haemoglobin <70 g L/1, blood transfusion, or that is judged to be the cause of death, is common and may account for a quarter of deaths after noncardiac surgery.
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