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Hypofibrinogenemia can be estimated by the predictive formula in aortic surgery

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Abstract

Objective

Aortic surgery often causes massive bleeding due to hypofibrinogenemia. Predicting hypofibrinogenemia is useful for developing a hemostasis strategy, including preparing for blood transfusion. We made a formula for predicting the serum fibrinogen level (SFL) at the termination of cardiopulmonary bypass (CPB) in aortic surgery and examined its validity.

Methods

We performed a retrospective observational study that consisted of 267 patients (group A) who underwent aortic surgery from July 2013 to December 2016 and made a formula for predicting the SFL at the termination of CPB in group A by a multiple linear regression analysis. The validity of this formula was then examined in another 60 patients (group B) who underwent aortic surgery from January 2017 to December 2017.

Results

We developed the following predictive formula: SFL at the termination of CPB (mg/dL) = 14.7 + 0.44 × preoperative SFL (mg/dL) + (− 0.14) × CPB time (min) + 0.64 × preoperative body weight (kg) + (− 17.3) × lateral thoracotomy (Yes/No, Yes: 1, No: 0). In group B, the predictive formula proved to be statistically valid in group B (R2 = 0.531, p < 0.001).

Conclusion

The SFL at the termination of CPB in aortic surgery can be predicted by the preoperative SFL, body weight, CPB time and surgical approach. The predictive formula is useful for developing a hemostasis strategy, including preparing for blood transfusion.

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Acknowledgements

Advice and comments given by Dr. Nishida and Dr. Matsui has been a great help in data analysis.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Toshihiko Nishi, Masato Mutsuga, Toshiaki Akita, Yuji Narita, Kazuro Fujimoto, Yoshiyuki Tokuda & Akihiko Usui

  2. Department of Biostatistics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Kazuki Nishida & Shigeyuki Matsui

  3. Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Kimitoshi Nishiwaki

Authors
  1. Toshihiko Nishi
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  2. Masato Mutsuga
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  3. Toshiaki Akita
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  4. Yuji Narita
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  5. Kazuro Fujimoto
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  6. Yoshiyuki Tokuda
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  7. Kazuki Nishida
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  8. Shigeyuki Matsui
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  9. Kimitoshi Nishiwaki
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  10. Akihiko Usui
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Corresponding author

Correspondence to Toshihiko Nishi.

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Supplementary Information

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11748_2021_1594_MOESM1_ESM.pdf

Supplemental Figure 1. An ROC analysis to identify the optimal cut-off value of the predicted SFL at the termination of CPB for hypofibrinogenemia (SFL at the termination of CPB ≤ 150 mg/dL) was performed. The optimal cut-off value was identified using the Youden index. The optimal cut-off value of the predicted SFL at the termination of CPB was 128 mg/dL in order to predict hypofibrinogenemia, with a sensitivity of 57.1%, specificity of 92.0% and ROC area of 0.815 (95% CI, 0.71-0.921). ROC receiver operating characteristic, SFL serum fibrinogen level, CPB cardiopulmonary bypass, CI confidence interval (PDF 61 KB)

Supplementary file2 (DOCX 14 KB)

Supplementary file3 (DOCX 16 KB)

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Nishi, T., Mutsuga, M., Akita, T. et al. Hypofibrinogenemia can be estimated by the predictive formula in aortic surgery. Gen Thorac Cardiovasc Surg 69, 1376–1382 (2021). https://doi.org/10.1007/s11748-021-01594-5

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  • DOI: https://doi.org/10.1007/s11748-021-01594-5

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