Contributing factors to heparin resistance during cardiopulmonary bypass

IF 1.1 4区医学 Q4 ENGINEERING, BIOMEDICAL Journal of Artificial Organs Pub Date : 2024-02-17 DOI:10.1007/s10047-024-01435-1

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Abstract

Since the risk factors for heparin resistance (HR) before cardiopulmonary bypass (CPB) have not been fully clarified, this study investigated the contributing factors for HR after the initial unfractionated heparin (UFH) dose of 500 IU/kg. We retrospectively analyzed the data of 371 patients who underwent CPB surgery, with the initial UFH dose of 500 IU/kg, between May 2017 and December 2021. We defined HR as the failure to achieve activated clotting time (ACT) of > 480 s after the initial UFH dose of 500 IU/kg. HR was observed in 36 patients (9.7%) (HR group), while HR was not observed in 335 patients (control group). The HR group included significantly more patients with preoperative use of UFH, with significantly higher white blood cell counts, fibrinogen, fibrinogen degradation products, d-dimer, and C-reactive protein, and lower hemoglobin and albumin. The multivariable logistic regression analysis identified albumin (OR: 3.09, 95% CI 1.3504–7.0845, p = 0.0075) and fibrinogen (OR: 0.99, 95% CI 0.9869–0.9963, p = 0.0003) as independent predictors for HR. Using the Youden index, the cutoffs of albumin and fibrinogen were calculated as 3.8 g/dL and 303 mg/dL, respectively. The receiver operating characteristic curves showed the predictive performance of albumin (area under the curve (AUC): 0.78, sensitivity: 65%, specificity: 81%) and fibrinogen (AUC: 0.77, sensitivity: 56%, specificity: 88%). The incidence of HR after the initial UFH dose of 500 IU/kg was 9.7%. The preoperative albumin < 3.8 g/dL and fibrinogen > 303 mg/dL were independent predictors for HR.

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心肺旁路过程中肝素抵抗的诱因

摘要由于心肺旁路（CPB）前肝素抵抗（HR）的风险因素尚未完全明确，本研究调查了初始非分叶肝素（UFH）剂量为 500 IU/kg 后导致 HR 的诱因。我们回顾性分析了2017年5月至2021年12月期间接受CPB手术、初始UFH剂量为500 IU/kg的371名患者的数据。我们将 HR 定义为初始 UFH 剂量为 500 IU/kg 后活化凝血时间（ACT）未能达到 > 480 s。有 36 例患者（9.7%）（HR 组）观察到 HR，而 335 例患者（对照组）未观察到 HR。HR组中术前使用UFH的患者明显增多，白细胞计数、纤维蛋白原、纤维蛋白原降解产物、d-二聚体和C反应蛋白明显升高，血红蛋白和白蛋白降低。多变量逻辑回归分析发现，白蛋白（OR：3.09，95% CI 1.3504-7.0845，p = 0.0075）和纤维蛋白原（OR：0.99，95% CI 0.9869-0.9963，p = 0.0003）是HR的独立预测因子。根据尤登指数计算，白蛋白和纤维蛋白原的临界值分别为 3.8 g/dL 和 303 mg/dL。接收器操作特征曲线显示白蛋白的预测性能（曲线下面积（AUC）：0.78，灵敏度：65%）：0.78，灵敏度：65%，特异性：81%）和纤维蛋白原（AUC：0.77，灵敏度：56%，特异性：88%）。初始 UFH 剂量为 500 IU/kg 后的 HR 发生率为 9.7%。术前白蛋白< 3.8 g/dL和纤维蛋白原> 303 mg/dL是HR的独立预测因子。

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来源期刊

Journal of Artificial Organs 医学-工程：生物医学

CiteScore

2.80

自引率

15.40%

发文量

审稿时长

6-12 weeks

期刊介绍： The aim of the Journal of Artificial Organs is to introduce to colleagues worldwide a broad spectrum of important new achievements in the field of artificial organs, ranging from fundamental research to clinical applications. The scope of the Journal of Artificial Organs encompasses but is not restricted to blood purification, cardiovascular intervention, biomaterials, and artificial metabolic organs. Additionally, the journal will cover technical and industrial innovations. Membership in the Japanese Society for Artificial Organs is not a prerequisite for submission.