Elevating the standards of hypofibrinogenemia in trauma: Higher thresholds of admission fibrinogen predict mortality and organ dysfunction.

BACKGROUND

The precise thresholds at which admission fibrinogen predicts mortality and organ dysfunction in trauma patients are unknown.

STUDY DESIGN AND

METHODS

Retrospective study at a single trauma center.

INCLUSION CRITERIA: 18-89 years, traumatic mechanism, transported from scene, and fibrinogen obtained within 30-min of arrival. Admission fibrinogen: <150, 150-199, 200-249, and ≥250 mg/dL.

PRIMARY OUTCOME: 28-day mortality. Multivariable logistic regression analysis described the risk of 28-day mortality by fibrinogen levels.

SECONDARY OUTCOMES: 24-h mortality, acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS). The optimal threshold of admission fibrinogen associated with AKI and ARDS was determined. Results reported as odds ratio (OR) with 95% confidence interval (CI).

RESULTS

Two thousand five hundred and five patients included. Admission fibrinogen: 94 (3.8%) <150 mg/dL, 225 (9.0%) 150-199 mg/dL, 533 (21.3%) 200-249 mg/dL, and 1653 (66.0%) ≥250 mg/dL. Twenty-eight-day mortality occurred in 239/2505 (9.5%), and 114/2505 (4.6%) died within 24 h. Fibrinogen <150 mg/dL (OR: 11.86, 95% CI: 5.80-24.26; p < .001) and fibrinogen 150-199 mg/dL (OR: 2.20, 95% CI 1.22-3.96; p = .009) were associated with 28-day mortality. Admission fibrinogen <150 and 150-200 mg/dL were also associated with 24 h mortality. The optimal cutoff of fibrinogen and AKI was <238 mg/dL, which predicted AKI (OR: 2.45, 95% CI: 1.4-4.4). The optimal cutoff of fibrinogen and ARDS was <235 mg/dL, and predicted ARDS (OR: 1.9, 95% CI: 1.01-3.55).

CONCLUSION

Admission hypofibrinogenemia <200 mg/dL is associated with 28-day and 24 h mortality in trauma patients. Admission fibrinogen is also a marker for post-traumatic AKI and ARDS.