scholarly journals Incidence, Risk Factors, and Outcomes of Stroke Following Cardiac Transplantation

Stroke ◽  
2021 ◽  
Author(s):  
Hilmi Alnsasra ◽  
Rabea Asleh ◽  
Neeraj Kumar ◽  
Camden Lopez ◽  
Takumi Toya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hemorrhagic Stroke ◽  
Calcineurin Inhibitor ◽  
Stroke Risk ◽  
Single Institution ◽  
Risk Of Death ◽  
Increased Risk ◽  
Incidence Risk ◽  
The Impact ◽  
Ischemic Events

Background and Purpose: Less is known about the risk factors and outcomes associated with stroke in the current era of increasing heart transplantation (HT) being performed in older patients. The impact of immunosuppression on risk of stroke has not yet been previously studied. We aimed to determine the incidence, risk factors and outcomes of stroke after HT. Methods: We retrospectively analyzed the incidence of ischemic and hemorrhagic strokes and associated outcomes in all consecutive HT recipients transplanted between 1994 and 2016 at a single institution. Results: Of 529 patients who underwent HT, 57 (10.7%) developed stroke, 8.1% had an ischemic events and (2.6%) had a hemorrhagic stroke. Age at HT (adjusted hazard ratio [HR] 1.33; P =0.03) and diabetes (HR, 2.60; P =0.02) were associated with increased risk of ischemic events. Patients with stroke (any type) were more likely to have worse kidney function (HR, 1.81; P =0.02) whereas patients with ischemic events were more likely to undergo combined organ transplantation (HR, 2.01; P =0.05). Cytomegalovirus infection was found to be associated with increased risk of any stroke (HR, 2.09; P =0.02).Conversion from calcineurin inhibitor to sirolimus-based immunosuppression was not found to be associated with a significant change in stroke risk (HR, 1.39; P =0. 45) compared with calcineurin inhibitor maintenance therapy. Stroke of any type and ischemic events were independently associated with increased risk of death (HR, 1.90; P =0.001 and HR, 2.14; P <0.001, respectively). Conclusions: Stroke after HT is associated with increased mortality. Older age at HT, diabetes, renal dysfunction, and CMV infection were associated with greater risk of stroke.

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Mary Cushman ◽  
Maciej Banach ◽  
Brett M Kissela ◽  
David C Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Stroke Risk Factors ◽  
Age Related ◽  
Increased Risk ◽  
The Impact ◽  
Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

scholarly journals The impact of parental risk factors on the risk of stroke in type 1 diabetes

2021 ◽  
Author(s):  
Anni Ylinen ◽  
◽  
Stefanie Hägg-Holmberg ◽  
Marika I. Eriksson ◽  
Carol Forsblom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Hemorrhagic Stroke ◽  
Cox Regression Analysis ◽  
Parental Risk Factors ◽  
Increased Risk ◽  
History Of ◽  
The Impact

Abstract Background Individuals with type 1 diabetes have a markedly increased risk of stroke. In the general population, genetic predisposition has been linked to increased risk of stroke, but this has not been assessed in type 1 diabetes. Our aim was, therefore, to study how parental risk factors affect the risk of stroke in individuals with type 1 diabetes. Methods This study represents an observational follow-up of 4011 individuals from the Finnish Diabetic Nephropathy Study, mean age at baseline 37.6 ± 11.9 years. All strokes during follow-up were verified from medical records or death certificates. The strokes were classified as either ischemic or hemorrhagic. All individuals filled out questionnaires concerning their parents’ medical history of hypertension, diabetes, stroke, and/or myocardial infarction. Results During a median follow-up of 12.4 (10.9–14.2) years, 188 individuals (4.6%) were diagnosed with their first ever stroke; 134 were ischemic and 54 hemorrhagic. In Cox regression analysis, a history of maternal stroke increased the risk of hemorrhagic stroke, hazard ratio 2.86 (95% confidence interval 1.27–6.44, p = 0.011) after adjustment for sex, age, BMI, retinal photocoagulation, and diabetic kidney disease. There was, however, no association between maternal stroke and ischemic stroke. No other associations between parental risk factors and ischemic or hemorrhagic stroke were observed. Conclusion A history of maternal stroke increases the risk of hemorrhagic stroke in individuals with type 1 diabetes. Other parental risk factors seem to have limited impact on the risk of stroke.

Switching to centrifugal pumps may decrease hemolysis rates among pediatric ECMO patients

Perfusion ◽  
2021 ◽  
pp. 026765912098257
Author(s):  
Kevin N Johnson ◽  
Benjamin Carr ◽  
George B Mychaliska ◽  
Ronald B Hirschl ◽  
Samir K Gadepalli
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Centrifugal Pumps ◽  
Single Center ◽  
Free Hemoglobin ◽  
Risk Of Death ◽  
Multivariable Logistic Regression ◽  
Increased Risk ◽  
The Impact ◽  
Significant Factors

Recent advances in ECLS technology have led to the adoption of centrifugal pumps for the majority of patients worldwide. Despite several advantages of centrifugal pumps, they remain controversial because a number of studies have shown increased rates of hemolysis. The aim of this study was to assess the impact of transitioning from roller to centrifugal pumps on hemolysis rates at our center. A retrospective analysis of all pediatric ECMO patients at a single center between 2005 and 2017 was undertaken. Hemolysis was defined as a plasma free hemoglobin >50 mg/dL. Multivariable logistic regression was performed correcting for several factors to determine risk factors for hemolysis and analyze outcomes among patients with hemolysis. Significant findings were those with p < 0.05. A total of 590 patients were identified during the study period. Multivariable logistic regression for risk factors for hemolysis showed roller pumps (OR 1.92, CI 1.11–3.33) and ECMO duration (OR 1.002 per hour, CI 1.00–1.01) to be significant factors. Rates of hemolysis significantly improved following conversion from roller to centrifugal pumps, with significantly lower rates of hemolysis in 2012, 2015, 2016, and 2017 when compared to the historical average with roller pumps from 2005 to 2009 (34.7%). Additionally, hemolysis was associated with an increased risk of death (OR 3.59, CI 2.05–6.29) when correcting for other factors. These data suggest decreasing rates of hemolysis with centrifugal pumps compared to roller pumps. Since hemolysis was also associated with increased risk of death, these data support the switch from roller to centrifugal pumps at ECMO centers.

scholarly journals Diabetes, even newly defined by HbA1c testing, is associated with an increased risk of in-hospital death in adults with COVID-19

2020 ◽  
Author(s):  
Ye Liu ◽  
Ran Lu ◽  
Junhong Wang ◽  
Qin Cheng ◽  
Ruitao Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Survival Probability ◽  
Cox Regression ◽  
Undiagnosed Diabetes ◽  
Hospital Death ◽  
Diabetes Group ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Abstract Aims: Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19.Methods: This retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients’ past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was 6.5% (≥ 48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis. Results: Of 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs 5.9%, p <0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p <0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥ 1.0 mg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19.Conclusions: The prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.

Abstract P418: Increased Pro-neurotensin/neuromedin N is Associated With Incident Ischemic Stroke

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Charles D Nicoli ◽  
Nicholas Wettersten ◽  
George Howard ◽  
Virginia J Howard ◽  
Suzanne E Judd ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Racial Differences ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Disease Risk ◽  
Stroke Risk Factors ◽  
Increased Risk ◽  
Ischemic Stroke Risk ◽  
Neuromedin N

Introduction: The neuropeptide neurotensin (NT) has been linked to cardiovascular and metabolic disease risk. Through measurement of its stable equimolar precursor, pro-neurotensin/neuromedin N (pro-NT/NMN), hyperactivity of NT has been associated with aggregate cardiovascular outcomes that include stroke. However, the exclusive association of pro-NT/NMN with incident ischemic or hemorrhagic stroke has not been studied. Hypothesis: Higher serum pro-NT/NMN is associated with incident ischemic and hemorrhagic stroke. Methods: Prospective case-cohort study in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. From 2003-2007, REGARDS enrolled 30,239 White or Black adults aged ≥45. Pro-NT/NMN was measured by immunoassay in 464 ischemic stroke cases, 49 hemorrhagic stroke cases, and 800 non-cases from a random cohort. Cox proportional-hazards models were used to calculate hazard ratios (HR) of stroke by pro-NT/NMN quartiles and per standard deviation (SD) of log pro-NT/NMN. Model 1 (both stroke types) included demographic factors as covariates, Model 2A (ischemic only) added ischemic stroke risk factors, and Model 2B (hemorrhagic only) added hemorrhagic stroke risk factors. Results: The table shows an increased HR of ischemic stroke for those in the 4th vs 1st-quartile pro-NT/NMN in Model 1 with a trend of increased risk across quartiles; this was attenuated in Model 2A. Prebaseline diabetes and coronary artery disease were the largest confounders of ischemic stroke risk, with each accounting for 19% of the association observed in Model 1. There was no association of pro-NT/NMN with hemorrhagic stroke in either model. There were no interactions of race or sex with log pro-NT/NMN. Conclusions: Higher pro-NT/NMN is associated with increased risk of ischemic stroke after adjusting for demographics, but this was not independent of stroke risk factors. No significant association with hemorrhagic stroke was observed; this analysis was limited by a small number of events.

scholarly journals 2613. The Epidemiology of Respiratory Syncytial Virus (RSV) in People with Immune Dysfunction Seen at a Tertiary Hospital Between 2010 and 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S908-S909
Author(s):  
Qiuju Li ◽  
Joanne Reekie ◽  
Marie Helleberg ◽  
Henrik Sengeløv ◽  
Søren Schwartz Sørensen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Syncytial Virus ◽  
Immune Dysfunction ◽  
Solid Organ ◽  
Cell Transplant ◽  
Risk Of Death ◽  
Increased Risk ◽  
Syncytial Virus ◽  
The Impact

Abstract Background Persons with a compromised immune system are at increased risk of complications related to respiratory syncytial virus (RSV) but the risks are not well defined. We aimed to investigate the prevalence of RSV infection, associated risk factors and complications in a large population of people with immune dysfunction. Methods Persons with immune dysfunction, first seen at Copenhagen University Hospital, Rigshospitalet, between January 1, 2010 and February 21, 2017, aged ≥18 were included. RSV testing and positivity (positive PCR or antigen test) was determined through the Danish Microbiology Database. Generalized estimating equations logistic regression was used to investigate the risk factors for RSV positivity; Cox regression was used to assess the impact of RSV positivity (time-updated) on mortality in the first 12 months after first visit. Results The study included 42,567 persons, of which 3,356 (7.9%, 95% CI 7.6%-8.1%) were tested for RSV at least once during follow-up, with 2,374 (71%) tested in the first 12 months. Stem cell transplant (HSCT) and solid-organ transplant (SOT) recipients had the highest proportion of persons tested for RSV (66.0%, 95% CI 62.9%–69.1% and 31.6%, 95% CI 29.0%–34.2%, respectively). Of those tested, 256 (7.6%, 95% CI 6.7%–8.5%) had ≥1 positive RSV test (figure). After adjustment, HSCT and SOT recipients, as well as other hematologic and rheumatologic patient groups were more likely to have a positive RSV test compared with persons seen in the infectious disease department. Fifty-seven RSV-related complications were identified in 53/256 (20.7%, 95% CI 15.7%-25.7%) persons positive for RSV (table), of which 24 (45.3%) were HSCT recipients and 18 (34.0%) were other hematologic patients. In the 12 months after first department visit, 9,451 (22%) patients died; persons with RSV had an increased risk of short-term mortality (aHR 1.77, 95% CI 1.19–2.64), adjusting for sex, age, patient group and flu positivity. Conclusion Patients with a hematological or rheumatological condition and SOT recipients had the highest odds of contracting RSV, with hematological patients in particular at an excess risk of RSV-related complications. RSV was associated with an increased risk of death in the first 12 months of patient follow-up. Disclosures All authors: No reported disclosures.

scholarly journals Diabetes, even newly defined by HbA1c testing, is associated with an increased risk of in-hospital death in adults with COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ye Liu ◽  
Ran Lu ◽  
Junhong Wang ◽  
Qin Cheng ◽  
Ruitao Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Survival Probability ◽  
Cox Regression ◽  
Undiagnosed Diabetes ◽  
Hospital Death ◽  
Diabetes Group ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Abstract Background Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19. Methods This retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients’ past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was ≥6.5% (48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis. Results Of 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs. 5.9%, p <  0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p <  0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥1.0 μg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19. Conclusions The prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.

scholarly journals Diabetes, Even Newly Defined by HbA1c Testing, Is Associated With an Increased Risk of in-hospital Death in Adults With COVID-19

2020 ◽  
Author(s):  
Ye Liu ◽  
Ran Lu ◽  
Junhong Wang ◽  
Qin Cheng ◽  
Ruitao Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Survival Probability ◽  
Cox Regression ◽  
Undiagnosed Diabetes ◽  
Hospital Death ◽  
Diabetes Group ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Abstract Background: Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19.Methods: This retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients’ past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was 6.5% (≥ 48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis. Results: Of 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs 5.9%, p <0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p <0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥ 1.0 mg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19.Conclusions: The prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.

scholarly journals Impact of Interstitial Pneumonia on the Survival and Risk Factors Analysis of Patients with Hematological Malignancy

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Wei-Liang Chen ◽  
Yu-Tzu Tsao ◽  
Tsun-Hou Chang ◽  
Tsu-Yi Chao ◽  
Woei-Yau Kao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Interstitial Pneumonia ◽  
Cox Regression ◽  
Hematological Malignancy ◽  
Prognostic Indicator ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Background. The emergence of interstitial pneumonia (IP) in patients with hematological malignancy (HM) is becoming a challenging scenario in current practice. However, detailed characterization and investigation of outcomes and risk factors on survival have not been addressed.Methods. We conducted a retrospective study of 42,584 cancer patients covering the period between 1996 and 2008 using the institutional cancer registry system. Among 816 HM patients, 61 patients with IP were recognized. The clinical features, laboratory results, and histological types were studied to determine the impact of IP on survival and identify the profile of prognostic factors.Results. HM patients with IP showed a significant worse survival than those without IP in the 5-year overall survival (P=0.027). The overall survival showed no significant difference between infectious pneumonia and noninfectious interstitial pneumonia (IIP versus nIIP) (P=0.323). In a multivariate Cox regression model, leukocyte and platelet count were associated with increased risk of death.Conclusions. The occurrence of IP in HM patients is associated with increased mortality. Of interest, nIIP is a prognostic indicator in patients with lymphoma but not in patients with leukemia. However, aggressive management of IP in patients with HM is strongly advised, and further prospective survey is warranted.

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

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