Impact of Intraoperative Plasma Infusion Dose on the Clinical Prognosis of Cardiac Surgery Patients / 中山大学学报(医学科学版)

ABSTRACT

ObjectiveTo assess the impact of intraoperative plasma infusion dose and coagulation test value INR on the clinical prognosis of patients undergoing cardiac surgery， providing a basis for guiding rational blood use during cardiac surgery. MethodsThe clinical data of 305 surgical patients who received fresh frozen plasma transfusion during cardiac surgery were collected in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2014 to December 2022. The patients were divided into low-dose group （plasma infusion dose <15 mL/kg， n = 214） and high-dose group （plasma infusion dose ≥15 mL/kg， n = 91） based on the intraoperative plasma dose. Univariate analysis， correlation analysis and logistic multivariate regression analysis were used to analyze the relationship between plasma infusion dose， changes in INR before and after plasma transfusion， and the clinical prognosis of patients undergoing cardiac surgery. ResultsThe median plasma infusion dose for all patients was 11.11 （8.17-19.05） mL/kg， while the median plasma infusion dose in the high-dose group and the low-dose group was 17.78 （15.69-20.91） mL/kg and 9.52 （7.77-11.43） mL/kg， respectively， with a statistically significant difference （P <0.001）. The median INR decrease in the high-dose and low-dose groups was 0.98 （0.60-1.26） and 0.50 （0.35-0.76）， respectively， with a statistically significant difference （P<0.001）. Logistic multivariate regression analysis revealed that abnormally elevated preoperative INR values increased the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （P<0.001）， with an OR 95%CI of 6.757（3.068， 14.822）. Additionally， it also increased the risk of postoperative in-hospital mortality （P< 0.001）， with an OR 95%CI of 5.441 （2.193， 13.499）. INR decrease reduced the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （P=0.001）， with an OR 95%CI of 0.244（0.107， 0.558）. Correlation analysis showed positive correlation between plasma infusion dose and postoperative ICU days （rs=0.569， P<0.001） and hospital days （rs=0.302， P<0.001） in cardiac surgery patients. ConclusionAmong patients undergoing cardiac surgery who receive intraoperative plasma transfusion， high plasma infusion dose and abnormally elevated preoperative INR values are associated with poorer clinical outcomes， while patients who show a greater degree of INR correction after plasma transfusion exhibit better clinical results.