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Title: AntiPORT: adaptation of a transfusion prediction score to an Australian cardiac surgery population.
Austin Authors: Yeates, James;Miles, Lachlan F ;Blatchford, Kate;Bailey, Michael;Williams-Spence, Jenni;Reid, Christopher;Coulson, Tim G 
Affiliation: Department of Anaesthesia, St Vincent's Hospital, Sydney, NSW, Australia.;Department of Medicine, University of Cambridge, Cambridge, United Kingdom.;School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
Department of Anaesthesia, St George Hospital, Sydney, NSW, Australia.
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
School of Public Health, Curtin University, Perth, WA, Australia.
Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.;Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, VIC, Australia.;Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia.
Issue Date: 5-Dec-2022
Date: 2023
Publication information: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine 2022-12-05; 24(4)
Abstract: Introduction: Risk scoring systems exist to predict perioperative blood transfusion risk in cardiac surgery, but none have been validated in the Australian or New Zealand population. The ACTA-PORT score was developed in the United Kingdom for this purpose. In this study, we validate and recalibrate the ACTA-PORT score in a large national database. Methods: We performed a retrospective validation study using data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database between 1 September 2016 and 31 December 2018. The ACTA-PORT score was calculated using an equivalent of EuroSCORE I. Discrimination and calibration was assessed using area under the receiver operating characteristic (AUROC) curves, Brier scores, and calibration plots. ACTA-PORT was then recalibrated in a development set using logistic regression and the outcome of transfusion to develop new predicted transfusion rates, termed "AntiPORT", using AusSCORE "all procedures" as the regional equivalent of EuroSCORE I. The accuracy of these new predictions was assessed as for ACTA-PORT. Results: 30 388 patients were included in the study at 37 Australian centres. The rate of red blood cell transfusion was 33%. Discrimination of ACTA-PORT was good but calibration was poor, with overprediction of transfusion (AUROC curve, 0.76; 95% CI, 0.75-0.76; Brier score, 0.19). The recalibrated AntiPORT showed significantly improved calibration in both development and validation sets without compromising discrimination (AUROC curve, 0.76; 95% CI, 0.75-0.76; Brier score, 0.18). Conclusions: The AntiPORT is the first red cell transfusion risk scoring system for cardiac surgery patients to be validated using Australian data. It is accurate and simple to calculate. The demonstrated accuracy of AntiPORT may help facilitate benchmarking and future research in patient blood management, as well as providing a useful tool to help clinicians target these resource-saving strategies.
DOI: 10.51893/2022.4.OA6
Journal: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
Start page: 360
End page: 368
PubMed URL: 38047003
Type: Journal Article
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