Modelling the association between fibrinogen concentration on admission and mortality in patients with massive transfusion after severe trauma: an analysis of a large regional database
Authors:
- Pierre BouzatPBPierre Bouzat
- François-Xavier AgeronFAFrançois-Xavier Ageron
- Jonathan CharbitJCJonathan Charbit
- Xavier BobbiaXBXavier Bobbia
- Pauline DerasPDPauline Deras
- Jennifer Bas Dit NuguesJNJennifer Bas Dit Nugues
- Etienne EscudierEEEtienne Escudier
- Guillaume MarcotteGMGuillaume Marcotte
- Marc LeoneMLMarc Leone
- Jean-Stéphane DavidJDJean-Stéphane David
Open Access
- 9 July 2018
- journal article
- research article
- Published by Springer Nature in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
- Vol. 26 (1) , 1-8
Abstract
The relationship between fibrinogen concentration and traumatic death has been poorly explored after severe trauma. Existing studies analysed this relationship in unselected trauma population, often considering fibrinogen concentration as a categorical variable. The aim of our study was to model the relationship between fibrinogen concentration and in-hospital mortality in severe trauma patients requiring massive transfusion using fibrinogen on admission as a continuous variable. We designed a retrospective observational study based on prospectively collected data from 2009 to 2015 in seven French level-I trauma centres. All consecutive patients requiring a transfusion of at least 10 packed red blood cells (RBC) within 24 h were included. To assess the relationship between in-hospital death and fibrinogen concentration on admission, we performed generalized linear and additive models with death as a dependent variable. We also assessed the relationship between fibrinogen concentration below 1.5 g.L− 1 and potential predictors. Within the study period, 366 patients were included. A non-linear relationship was found between fibrinogen concentration and death. Graphical modelling of this relationship depicted a negative association between fibrinogen levels and death below a fibrinogen concentration of 1.5 g.L− 1. Predictors of low fibrinogen concentration (< 1.5 g.L− 1) were systolic blood pressure, Glasgow coma scale and haemoglobin concentration on admission. A complex and robust approach for modelling the relationship between fibrinogen and mortality revealed a critical fibrinogen threshold of 1.5 g.L− 1 for severe trauma patients requiring massive transfusion. This trigger may guide the administration of procoagulant therapies in this context.Keywords
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