Plasma Fibrinogen Level on Admission to the Intensive Care Unit is a Powerful Predictor of Postoperative Bleeding after Cardiac Surgery with Cardiopulmonary Bypass

INTRODUCTION:

Evidence regarding the behavior of fibrinogen
levels and the relation between fibrinogen levels and postoperative
bleeding is limited in cardiac surgery
under cardiopulmonary bypass (CPB). To evaluate perioperative
fibrinogen levels as a predictor of postoperative bleeding in patients
undergoing cardiac surgery with CPB.

MATERIALS AND METHODS:

In this prospective, single-center, observational cohort study of 1956 patients following cardiac surgery
with CPB, fibrinogen level was measured perioperatively. Excessive
bleeding group was defined as patients with a 24-h chest tube output
(CTO) exceeded the 90th percentile of distribution.

RESULTS:

The
median 24-h CTO was 728.6±431.1ml. A total of 189 patients (9.7%) were
identified as having excessive bleeding. At admission to the intensive
care (Day 0), the fibrinogen levels were 2.5±0.8g/l and 2.1±0.8g/l in
the control and excessive bleeding groups, respectively (P<0.0001). The fibrinogen level on Day 0 was significantly correlated with the 24-h CTO (rho=-0.237; P<0.0001). Multivariate analysis demonstrated that the fibrinogen level at Day 0 was the best perioperative standard laboratory test to predict excessive bleeding (P=0.0001; odds ratio, 0.5), whereas preoperative fibrinogen level was not a predictor. Using receiver operating characteristics curve analyses, the best Day 0 fibrinogen level cutoff to predict postoperative bleeding was 2.2g/l.

CONCLUSIONS:

In
this large prospective study, the fibrinogen level upon admission to
the intensive care unit after CPB predicted the risk of postoperative
bleeding. Our data add to the concern regarding the fibrinogen level
threshold that might require fibrinogen concentrate infusion to reduce
postoperative blood loss.