Multicenter external validation of the FW-TRIC score for predicting red blood cell transfusion in on-pump cardiac surgery.

Abstract

Background: Perioperative red blood cell (RBC) transfusion remains common in cardiac surgery and is associated with increased morbidity and mortality. Accurate preoperative risk prediction is essential for patient blood management. The Fuwai-transfusion risk of on-pump cardiac surgery (FW-TRIC) score was previously developed and internally validated as a tool to estimate transfusion risk. This study aimed to externally validate the FW-TRIC score in a multicenter cohort.

Methods: A retrospective multicenter study was conducted across nine cardiovascular centers in China from January to December 2024. Adult patients undergoing on-pump cardiac surgery were included, while those undergoing transplantation, mechanical circulatory support, or preoperative transfusion were excluded. The discriminative performance of the FW-TRIC score was evaluated using receiver operating characteristic (ROC) curve analysis, and calibration was assessed through linear regression of observed versus predicted transfusion rates.

Results: A total of 3,287 patients met inclusion criteria, with an overall perioperative RBC transfusion rate of 40.1%. The FW-TRIC score demonstrated good discrimination for predicting transfusion, with an AUC of 0.713 (95% CI, 0.696-0.731) and excellent calibration. All individual predictors of FW-TRIC score, including age, sex, NYHA classification, body surface area, previous cardiac surgery, emergency surgery, and surgery type, underperformed the prediction ability of FW-TRIC score (all P < 0.05 for AUC comparison). Performance remained good across all nine centers (AUCs > 0.65). Across all transfusion risk categories in the external validation cohort, the observed transfusion rates compared well with those predicted by the FW-TRIC model.

Conclusions: The FW-TRIC score was externally validated as a robust and generalizable preoperative tool for predicting perioperative RBC transfusion in on-pump cardiac surgery. Its use enables effective transfusion risk stratification and supports personalized patient blood management strategies across diverse clinical settings.