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. 2022 Oct-Dec;25(4):485-489.
doi: 10.4103/aca.aca_103_21.

Preoperative fibrinogen level and postcardiac surgery morbidity and mortality rates

Pierre Fricault  1 , Juliette Piot  1 , Cécile Estève  1 , Veaceslav Savan  1 , Alexandre Sebesteyn  2 , Michel Durand  1 , Olivier Chavanon  2 , Pierre Albaladejo  1
Affiliations

Preoperative fibrinogen level and postcardiac surgery morbidity and mortality rates

Pierre Fricault et al. Ann Card Anaesth. 2022 Oct-Dec.

Abstract

Background: High preoperative fibrinogen levels are associated with reduced bleeding rates after cardiac surgery. Fibrinogen is directly involved in inflammatory processes and is a cardiovascular risk factors. Whether high fibrinogen levels before cardiac surgery are a risk factor for mortality or morbidity remains unclear.

Aims: This study aimed to examine the association between preoperative fibrinogen levels and mortality and morbidity rates after cardiac surgery.

Settings and design: This is a single-center retrospective study.

Material and methods: Patients (n = 1628) were divided into high (HFGr) and normal (NFGr) fibrinogen level groups, based on the cutoff value of 3.3 g/L, derived from the receiver operating characteristic (ROC) curve analysis. The primary outcome was the 30-day mortality rate. The rates of postoperative complications, including postoperative bleeding and transfusion rates, were examined.

Statistical analysis: Between-group comparisons were performed with the Mann-Whitney U test and Chi-squared test, as suitable. Model discriminative power was examined with the area under the ROC curve.

Results: The HFGr and NFGr included 1103 and 525 patients, respectively. Mortality rate was higher in the HFGr than in the NFGr (2.7% vs. 1.1%, P = 0.04). The 12-h bleeding volume (280 mL [195-400] vs. 305 mL [225-435], P = 0.0003) and 24-h bleeding volume values (400 mL [300-550] vs. 450 mL [340-620], P < 0.0001) were lower in the HFGr than in the NFGr. However, the rate of red blood cell transfusion during hospitalization was higher in the HFGr than in the NFGr (21.7% vs. 5.9%, P = 0.0103). Major complications were more frequent in the HFGr than in the NFGr.

Conclusion: High fibrinogen levels were associated with reduced postoperative bleeding volume and increased mortality and morbidity rates.

Keywords: Cardiac surgery; fibrinogen; morbidity; mortality.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve for mortality rates associated with Euroscore 2, preoperative fibrinogen level, Euroscore 2 and high fibrinogen group (HFGr) and normal fibrinogen group (NFGr), Euroscore 2 and preoperative fibrinogen (g/L)
See this image and copyright information in PMC

References

    1. Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA) Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018;32:88–120. - PubMed
    1. Gielen CL, Grimbergen J, Klautz RJ, Koopman J, Quax PH. Fibrinogen reduction and coagulation in cardiac surgery: An investigational study. Blood Coagul Fibrinolysis. 2015;26:613–20. - PubMed
    1. Faraoni D, Willems A, Savan V, Demanet H, De Ville A, Van der Linden P. Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery. Eur J Anaesthesiol. 2014;31:1–10. - PubMed
    1. Gielen C, Dekkers O, Stijnen T, Schoones J, Brand A, Klautz R, et al. The effects of pre- and postoperative fibrinogen levels on blood loss after cardiac surgery: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2014;18:292–8. - PMC - PubMed
    1. Kindo M, Hoang Minh T, Gerelli S, Perrier S, Meyer N, Schaeffer M, et al. Plasma fibrinogen level on admission to the intensive care unit is a powerful predictor of postoperative bleeding after cardiac surgery with cardiopulmonary bypass. Thromb Res. 2014;134:360–8. - PubMed