Ranucci M, Jeppsson A, Baryshnikova E
Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese (Milan), Italy.
Acta Anaesthesiol Scand. 2015 Apr;59(4):427-33. doi: 10.1111/aas.12469. Epub 2015 Jan 20.
Pre-operative fibrinogen levels are negatively associated with postoperative bleeding in cardiac surgery patients. The guidelines of the European Society of Anaesthesiology consider the possibility of a prophylactic pre-operative supplementation in patients with fibrinogen levels<`3.8 g/l. The present study is a reanalysis of published data aimed to define the diagnostic accuracy of different values of pre-operative fibrinogen levels in predicting severe post-operative bleeding.
Data were retrieved for 2154 patients in four different studies. Severe bleeding (SB) was defined as a post-operative chest drain output>1 l/12 h. Diagnostic accuracy for prediction of SB was tested at three cutoff values of pre-operative fibrinogen (2.5 g/l, 3.0 g/l, and 3.8 g/l).
At all the three cutoff values, pre-operative fibrinogen levels had an excellent negative predictive value, ranging from 86% to 100%. Conversely, the positive predictive value was poor at all the cutoff levels: 12% (3.8 g/l), 14% (3.0 g/l), and 19% (2.5 g/l). Overall, the accuracy of pre-operative fibrinogen levels for the prediction of SB was poor. A strategy based on pre-operative fibrinogen supplementation would lead to inappropriate treatment in > 80% of the treated patients. Overall, a trigger value of 3.8 g/l would result in an inappropriate treatment in 52% of the patients, of 3.0 g/l in 20% of the patients, and of 2.5 g/l in 4% of the patients.
Correction of pre-operative fibrinogen levels below 3.8 g/l would lead to an excessive rate of inappropriate interventions. Values below 2.5 g/l could be considered.
心脏手术患者术前纤维蛋白原水平与术后出血呈负相关。欧洲麻醉学会指南考虑对纤维蛋白原水平<3.8 g/l的患者进行术前预防性补充。本研究是对已发表数据的重新分析，旨在确定术前不同纤维蛋白原水平值预测严重术后出血的诊断准确性。
检索了四项不同研究中2154例患者的数据。严重出血（SB）定义为术后胸腔引流量>1 l/12 h。在术前纤维蛋白原的三个临界值（2.5 g/l、3.0 g/l和3.8 g/l）下测试预测SB的诊断准确性。
在所有三个临界值下，术前纤维蛋白原水平均具有出色的阴性预测价值，范围为86%至100%。相反，在所有临界水平下阳性预测价值均较差：12%（3.8 g/l）、14%（3.0 g/l）和19%（2.5 g/l）。总体而言，术前纤维蛋白原水平预测SB的准确性较差。基于术前补充纤维蛋白原的策略将导致超过80%的接受治疗患者接受不适当的治疗。总体而言，触发值为3.8 g/l会导致52%的患者接受不适当治疗，3.0 g/l会导致20%的患者接受不适当治疗，2.5 g/l会导致4%的患者接受不适当治疗。
纠正术前低于3.8 g/l的纤维蛋白原水平会导致不适当干预的比例过高。低于2.5 g/l的值可以考虑。
