Soluble transferrin receptor is associated with red blood cell transfusion in infant cardiac surgery

Background: Iron deficiency (ID) is linked to an increased need for perioperative red blood cell (RBC) transfusion in cardiac surgery. Traditional markers used to assess ID are often influenced by inflammation, whereas soluble transferrin receptor (sTfR) is less affected by inflammation. Therefore, the purpose of this study is to explore the relationship between sTfR levels and the need for high-volume RBC transfusion in pediatric cardiac surgery patients. Methods: From August 2021 to July 2022, 236 low-weight infants (<= 10 kg) who underwent cardiac surgery were included in this study. Preoperative sTfR levels and the volume of RBCs perioperatively transfused were recorded. Receiver operating characteristic (ROC) curve analysis and multivariable logistic model were used to explore the association between sTfR levels and the need for a high-volume of RBC transfusion in this study. Results: In our study, 29 (12.3%) patients received more than 2 units during the perioperative period. sTfR level was the most accurate marker for predicting the need for RBC transfusion [area under the curve (AUC) =0.643; 95% confidence interval (CI): 0.531-0.756]. Moreover, in both the continuous and categorical variable-adjusted models, a high sTfR level was associated with a greater need for RBC transfusion (P=0.006; P<0.001). Conclusions: RBC transfusion is common for low-weight infants undergoing cardiac surgery. Furthermore, a high preoperative sTfR level is associated with the need for a high-volume perioperative RBC transfusion.