Korean Journal of Anesthesiology

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Clinical Research Article

DOI: https://doi.org/10.4097/kja.23415
Association between De Ritis ratio and intraoperative blood transfusion in patients undergoing surgical clipping of unruptured intracranial aneurysms: a single center, retrospective, propensity score-matched study
Ji-Hoon Sim  , Chan-Sik Kim  , Seungil Ha  , Hyunkook Kim  , Yong-Seok Park  , Joung Uk Kim 
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author: Yong-Seok Park ,Tel: +82-2-3010-1448, Fax: +82-2-3010-6790, Email: parkys@amc.seoul.kr
Received: May 26, 2023; Revised: October 12, 2023   Accepted: November 13, 2023.
Abstract
Background
Although elective surgery for unruptured intracranial aneurysms (UIA) has increased, few studies have evaluated the risk factors for transfusion during UIA surgery. We evaluated the association between the preoperative De Ritis ratio (aspartate transaminase/alanine transaminase) and the incidence of intraoperative transfusion in patients who had undergone surgical UIA clipping.
Methods
Patients who underwent surgical clipping of UIA were stratified into two groups according to the preoperative De Ritis ratio cutoff levels (< 1.54 and ≥ 1.54), and the propensity score (PS)-matching analysis was performed to compare the incidence of intraoperative transfusion. Logistic regression analyses were performed to determine the risk factors for intraoperative transfusion. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were performed to verify the improvement in the intraoperative transfusion predictive model upon addition of the De Ritis ratio.
Results
Intraoperative transfusion incidence was 15.4% (77/502). We observed significant differences in the incidence of intraoperative transfusion (16.2% vs. 39.7%, P = 0.004) between the groups after matching. In the logistic regression analyses, the De Ritis ratio ≥ 1.54 was an independent risk factor for transfusion (odds ratio [OR]: 3.04, 95% CI [1.53, 6.03], P = 0.002). Preoperative hemoglobin (Hb) value was a risk factor for transfusion (OR: 0.33, 95% CI [0.24, 0.47], P < 0.001). NRI and IDI analyses showed that the De Ritis ratio improved the intraoperative blood transfusion predictive models (P = 0.031 and P = 0.049, respectively).
Conclusions
De Ritis ratio maybe a significant risk factor for intraoperative transfusion in UIA surgery.

Keywords :Alanine transaminase; Aspartate aminotransferases; Blood coagulation; Blood transfusion; Intracranial aneurysm; Propensity score

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