title: Plasma fibrinogen level on admission to the intensive care unit is a powerful predictor of postoperative bleeding after cardiac surgery with cardiopulmonary bypass.
abstract: BACKGROUND
  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.
  
  
  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.
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France. Electronic address: michel.kindo@chru-strasbourg.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Kindo
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Tam
authors.initials: T
authors.lastname: Hoang Minh
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gerelli
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Perrier
authors.affiliation: Department of Public Health, University Hospitals of Strasbourg, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.affiliation: Department of Public Health, University Hospitals of Strasbourg, France.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Schaeffer
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bentz
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Announe
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mommerot
authors.affiliation: Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Collange
authors.affiliation: Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Pottecher
authors.affiliation: Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Cristinar
authors.affiliation: Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Thiranos
authors.affiliation: Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Gros
authors.affiliation: Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
authors.forename: Paul-Michel
authors.initials: PM
authors.lastname: Mertes
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Billaud
authors.affiliation: Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Mazzucotelli
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D006454:Hemoglobins; D005340:Fibrinogen
keywords: Cardiopulmonary Bypass; Coronary Disease; Fibrinogen; Heart Valve Diseases; Hemostasis, Surgical; Postoperative blood loss