Paydar Shahram, Dalfardi Behnam, Shayan Zahra, Shayan Leila, Saem Jalal, Bolandparvaz Shahram
Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
J Emerg Trauma Shock. 2018 Jan-Mar;11(1):38-41. doi: 10.4103/JETS.JETS_37_17.
BACKGROUND: Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy. AIMS: The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients. SETTINGS AND DESIGN: This 2-year retrospective work examined the data of major trauma patients that were referred to Shahid Rajaee Hospital's emergency room in hemorrhagic shock condition. MATERIALS AND METHODS: Fibrinogen level was assessed for these patients on their arrival at our facility. Along with clinical and routine paraclinical variables, we evaluated the predictive value of these variables for a fibrinogen level below 100 mg/ml. RESULTS: A total of 855 cases were included (females: 16.4%; and males: 83.6%) in the study. The mean ± SD age was 36 ± 17.9 years, and the mean ± SD injury severity score was 12.2 ± 9. Motor vehicle accident was the most common cause of injury. Three factors, including arterial pH (cut off point = 7.34; area under the curve [AUC]: 0.59), base excess (cutoff point = -4.3; AUC: 0.60), and patients' gender had a significant association with the fibrinogen level under 100 mg/ml. When three factors of pH, BE, and patients' gender are being assessed simultaneously, the AUC became 0.62 (the predictive ability improved). CONCLUSIONS: Variables, including arterial pH, BE level, and patients' gender have predictive value for fibrinogen transfusion in trauma.
背景:失控性出血仍然是创伤相关死亡的主要原因。导致急性创伤性凝血病,尤其是低纤维蛋白原血症的事件,使得出血控制变得困难。及时预测、诊断和处理创伤性凝血病至关重要。 目的:本研究的目的是确定可预测急性创伤患者低纤维蛋白原血症的临床及易于获得的实验室变量。 设置与设计:这项为期2年的回顾性研究检查了转诊至沙希德拉贾伊医院急诊室的失血性休克重症创伤患者的数据。 材料与方法:这些患者到达我院时评估其纤维蛋白原水平。除临床和常规辅助检查变量外,我们评估了这些变量对纤维蛋白原水平低于100mg/ml的预测价值。 结果:本研究共纳入855例患者(女性:16.4%;男性:83.6%)。平均年龄±标准差为36±17.9岁,平均损伤严重程度评分±标准差为12.2±9。机动车事故是最常见的致伤原因。三个因素,包括动脉血pH值(截断点=7.34;曲线下面积[AUC]:0.59)、碱剩余(截断点=-4.3;AUC:0.60)以及患者性别,与纤维蛋白原水平低于100mg/ml显著相关。当同时评估pH值、碱剩余和患者性别的三个因素时,AUC变为0.62(预测能力提高)。 结论:包括动脉血pH值、碱剩余水平和患者性别在内的变量对创伤患者纤维蛋白原输注具有预测价值。
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