Prospective, Randomized Study of Fibrinogen Concentrate Versus Cryoprecipitate for Correcting Hypofibrinogenemia in Cardiac Surgery Patients.

OBJECTIVE: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with hypofibrinogenemia and severe bleeding requiring transfusion. Guidelines recommend cryoprecipitate or fibrinogen concentrate (FC) for the treatment of acquired hypofibrinogenemia. This study compared cryoprecipitate and FC for the correction of acquired hypofibrinogenemia and the associated costs. DESIGN: A single-center, prospective, randomized study evaluating patients with hypofibrinogenemia after cardiac surgery. The primary endpoint was direct treatment cost. Secondary endpoints included the change in fibrinogen level after FC and/or cryoprecipitate dosing. SETTING: A single-center study in Astana, Kazakhstan. PARTICIPANTS: Participants who underwent CPB from 2021 to 2022 and developed clinically significant bleeding and hypofibrinogenemia. INTERVENTIONS: Patients were randomized to receive cryoprecipitate or FC. MEASUREMENTS AND MAIN RESULTS: Eighty-eight adult patients with acquired hypofibrinogenemia (<2.0 g/L) after CPB were randomized to receive cryoprecipitate (N = 40) or FC (N = 48), with similar demographics between groups. Overall, mean ± SD 9.33 ± 0.94 units (range, 8-10) cryoprecipitate or 1.40 ± 0.49 g (1-2) FC was administered to the 2 groups. From before administration to 24 hours after, mean plasma fibrinogen increased by a mean ± SD of 125 ± 65 and 96 ± 65 mg/dL in the cryoprecipitate and FC groups, respectively. At 48 hours after administration, there was no significant difference in fibrinogen levels between groups. The mean direct cost of treatment with FC was significantly lower than with cryoprecipitate (p < 0.0001): $1,505.06 ± $152.40 and $631.75 ± $223.67 per patient for cryoprecipitate and FC, respectively. CONCLUSION: Analysis of plasma fibrinogen concentration showed that cryoprecipitate and FC had comparable effectiveness. However, FC is advantageous over cryoprecipitate due to its ease of handling, lower cost, and high purity.

Reliability of Scales With Second-Order Structure: Evaluation of Coefficient Alpha's Population Slippage Using Latent Variable Modeling.

A readily applicable procedure is discussed that allows evaluation of the discrepancy between the popular coefficient alpha and the reliability coefficient of a scale with second-order factorial structure that is frequently of relevance in empirical educational and psychological research. The approach is developed within the framework of the widely used latent variable modeling methodology and permits point and interval estimation of the slippage of alpha from scale reliability in a population under investigation. The method is useful when examining the consistency of complex structure measuring instruments assessing higher order latent constructs and, under its assumptions, represents a generally recommendable alternative to coefficient alpha. The outlined procedure is illustrated using data from an authoritarianism study.

Examining Construct Congruence for Psychometric Tests: A Note on an Extension to Binary Items and Nesting Effects.

This article extends the procedure outlined in the article by Raykov, Marcoulides, and Tong for testing congruence of latent constructs to the setting of binary items and clustering effects. In this widely used setting in contemporary educational and psychological research, the method can be used to examine if two or more homogeneous multicomponent instruments with distinct components measure the same construct. The approach is useful in scale construction and development research as well as in construct validation investigations. The discussed method is illustrated with data from a scholastic aptitude assessment study.

Examining Measurement Invariance and Differential Item Functioning With Discrete Latent Construct Indicators: A Note on a Multiple Testing Procedure.

A latent variable modeling method for studying measurement invariance when evaluating latent constructs with multiple binary or binary scored items with no guessing is outlined. The approach extends the continuous indicator procedure described by Raykov and colleagues, utilizes similarly the false discovery rate approach to multiple testing, and permits one to locate violations of measurement invariance in loading or threshold parameters. The discussed method does not require selection of a reference observed variable and is directly applicable for studying differential item functioning with one- or two-parameter item response models. The extended procedure is illustrated on an empirical data set.