Meyer Martin A S, Ostrowski Sisse R, Sørensen Anne Marie, Meyer Anna Sina P, Holcomb John B, Wade Charles E, Johansson Pär I, Stensballe Jakob
Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas.
Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark.
J Surg Res. 2015 Apr;194(2):581-590. doi: 10.1016/j.jss.2014.11.021. Epub 2014 Nov 20.
Identifying hypofibrinogenemia in trauma is important. The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational thromboelastometry FIBTEM in trauma patients and compared these with the plasma-based Clauss method.
Prospective study of consecutive adult trauma patients admitted to a level I trauma center. Levels of fibrinogen were analyzed by Clauss, FF, and FIBTEM on arrival. These methods were compared, and we then investigated whether specific cutoffs of fibrinogen levels were indicative for an increased risk of receiving a transfusion within the initial 6 h.
A total of 182 patients with an Injury Severity Score of 17 (9-26) were enrolled. Functional fibrinogen maximum amplitude (FF MA) and FIBTEM maximum clot firmness (MCF) had identical correlation coefficients when compared with those of Clauss fibrinogen (both ρ = 0.64, P < 0.001), and FF MA and FIBTEM MCF correlated with each other (ρ = 0.71, P < 0.001). By logistic regression, the following cutoffs of fibrinogen levels were associated with increased odds of receiving a transfusion, red blood cell concentrates: Clauss <2.5 g/L, FF MA <14.9 mm, FIBTEM MCF <10 mm; fresh frozen plasma and platelets: Clauss <2.5 g/L, FF MA <16.9 mm, FIBTEM MCF <14 mm.
The viscoelastic hemostatic assays for determining fibrinogen levels, FIBTEM and FF, are both correlated with the Clauss fibrinogen level, and there are no differences in the strength of these correlations. In this study, specific fibrinogen levels at arrival to the emergency department were indicative, although not necessarily causal, of increased odds of receiving a transfusion.
识别创伤患者中的低纤维蛋白原血症很重要。目前尚不清楚测定纤维蛋白原的最佳方法。因此，我们评估了通过两种全血粘弹性止血检测方法（血栓弹力图功能纤维蛋白原（FF）和旋转血栓弹力测定法FIBTEM）测定的创伤患者纤维蛋白原水平，并将其与基于血浆的Clauss方法进行比较。
对入住一级创伤中心的连续成年创伤患者进行前瞻性研究。患者入院时通过Clauss法、FF法和FIBTEM法分析纤维蛋白原水平。对这些方法进行比较，然后我们研究纤维蛋白原水平的特定临界值是否表明在最初6小时内接受输血的风险增加。
共纳入182例损伤严重程度评分为17（9 - 26）的患者。与Clauss纤维蛋白原相比，功能纤维蛋白原最大振幅（FF MA）和FIBTEM最大血凝块硬度（MCF）具有相同的相关系数（两者ρ = 0.64，P < 0.001），且FF MA和FIBTEM MCF相互相关（ρ = 0.71，P < 0.001）。通过逻辑回归分析，以下纤维蛋白原水平临界值与接受红细胞浓缩液输血几率增加相关：Clauss法<2.5 g/L，FF MA<14.9 mm，FIBTEM MCF<10 mm；与接受新鲜冰冻血浆和血小板输血几率增加相关：Clauss法<2.5 g/L，FF MA<16.9 mm，FIBTEM MCF<14 mm。
用于测定纤维蛋白原水平的粘弹性止血检测方法FIBTEM和FF均与Clauss纤维蛋白原水平相关，且这些相关性的强度无差异。在本研究中，患者到达急诊科时的特定纤维蛋白原水平表明接受输血几率增加，尽管不一定存在因果关系。
