Rita AtaÃde Silva
Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
Title: Fibrinogen relation to outcomes in congenital heart surgery
Biography
Biography: Rita AtaÃde Silva
Abstract
Congenital heart surgery is an evolving field with still much to comprehend regarding hemostasis and bleeding control. Lower fibrinogen levels have been related to blood products transfusion and potential morbidity. We sought to evaluate the relation of fibrinogen to outcomes in congenital heart surgery in our population.
This is a single center retrospective trial. We included all patients admitted to the Pediatric Intensive Care Unit (PICU) and submitted to congenital heart surgery during a 19-month period. Primary outcome was death during surgery or PICU stay. Secondary outcomes were amount of blood products transfusion in the operating room (OR) or PICU, low output cardiac syndrome (LOCS), acute kidney injury (AKI), mechanical invasive ventilation (MIV) length and PICU stay length. Statistical inference was performed using R CRAN version 3.5.0. Linear regression and ANOVA were used for continuous variable correlation and student T-test for continuous and binomial variables correlation.
There were a total of 204 evaluated patients. Mean age at surgery was 4.4 years (SD 6.4). Neonatal surgery was performed in 34 patients (18%). Fibrinogen level before surgery was 3.19 g/L (SD 0.88), with lower values related to the neonatal age (p<0.001). Fibrinogen level after surgery was 2.00 g/L (SD 0.60). Regarding the primary outcome, there were 9 deaths (4.4%). Both neonatal age (p=0.001) and lower fibrinogen levels before surgery (p=0.003, mean value of 2.22 g/L (SD 1.01) vs. 3.23 g/L (SD 0.86)) were related to death. Regarding the secondary outcomes, lower fibrinogen levels after surgery were related to higher amount of blood products transfusion in PICU (p<0.001), LOCS (p=0.001), AKI (p=0.001), and PICU length of stay (p=0.038).
In our small cohort, fibrinogen levels tend to be lower in the neonatal age. These values appear to have some relation to mortality and morbidity after congenital heart surgery. Although these outcomes tend to be multifactorial, the potential role of fibrinogen certainly deserves further study.