Preoperative fibrinogen level and postcardiac surgery morbidity and mortality rates

Authors: Fricault, P; Piot, J; Estève, C; Savan, V; Sebesteyn, A; Durand, M; Chavanon, O; Albaladejo, P

Affiliations: Department of Anesthesiology and Critical Care, University Hospital, Grenoble, France. Department of Cardiac Surgery, University Hospital, Grenoble, France.

Publication: Annals of cardiac anaesthesia ; 2022 ; 25. 485–489

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 factor. 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.