Dept. of Anaesthesiology and Intensive Care, Péterfy Hospital and Trauma Centre, Budapest, Hungary.
Physiological Research Controls Centre, Óbuda University, Budapest, Hungary; Department of Statistics, Corvinus University of Budapest, Budapest, Hungary.
Injury. 2021 Mar;52 Suppl 1:S15-S20. doi: 10.1016/j.injury.2020.12.002. Epub 2020 Dec 31.
Bleeding and coagulopathy are leading causes of morbidity and lethal outcome after multiple injuries. The pathophysiology of traumatic coagulopathy is under extensive investigations and recent results highlighted the central role of fibrinogen and the fibrin polymerisation process. Our goal was to investigate the factors influencing fibrinogen level and the consequences of hypofibrinogenaemia with clinical importance.
We conducted a retrospective analysis enrolling adult patients admitted to the shock room of a tertiary trauma centre in Hungary. Beside coagulation values, demographic data, injury related, transfusion and outcome parameters were collected from the hospital electronic charts. Only patients with complete e-chart were involved into final analysis. Multivariate linear and proportional odds logistic regression models were used to model outcomes - admission fibrinogen and SOFA score - controlling for age, sex, BMI, ISS and lactic acidosis.
54 patients were enrolled in final analysis. Among the parameters analysed, BMI was positively associated with fibrinogen level at admission (+0.23 g/l for every 5 unit of increase in BMI, 95% CI: 0.09-0.37, p=0.0021). Increased risk of transfusion was observed, if fibrinogen at admission was about 1.8 g/l or lower. Beside age and ISS, fibrinogen concentration was also a determinant of early organ failures as it negatively correlated with SOFA scores within 24 hours or care (OR=2.42, 95% CI: 1.05-5.62, for 1 g/l decrease, p=0.0388).
In our trauma cohort BMI seems to significantly influence fibrinogen level at admission. This result draws our attention to the possible differences of haemostasis process, and consequently different diagnostic and therapeutic thresholds in the management of obese trauma patients. Moderate hypofibrinogenaemia increases transfusion risk and beside ISS might be a prognostic factor of early MOF after multiple injuries.
出血和凝血障碍是多发伤患者发病率和致死率升高的主要原因。创伤性凝血病的病理生理学正在广泛研究中，最近的研究结果强调了纤维蛋白原和纤维蛋白聚合过程的核心作用。我们的目标是研究影响纤维蛋白原水平的因素以及低纤维蛋白原血症的临床重要性。
我们进行了一项回顾性分析，纳入了匈牙利一家三级创伤中心休克病房的成年患者。除了凝血值外，还从医院电子病历中收集了人口统计学数据、损伤相关、输血和预后参数。只有完成电子病历的患者才被纳入最终分析。使用多元线性和比例优势逻辑回归模型来对结果（入院纤维蛋白原和 SOFA 评分）进行建模，同时控制年龄、性别、BMI、ISS 和乳酸酸中毒。
最终分析纳入了 54 名患者。在分析的参数中，BMI 与入院时纤维蛋白原水平呈正相关（BMI 每增加 5 个单位，纤维蛋白原水平增加 0.23 g/L，95%CI：0.09-0.37，p=0.0021）。如果入院时纤维蛋白原约为 1.8 g/L 或更低，则观察到输血风险增加。除了年龄和 ISS 外，纤维蛋白原浓度也是早期器官衰竭的决定因素，因为它与 24 小时内或治疗期间的 SOFA 评分呈负相关（OR=2.42，95%CI：1.05-5.62，每降低 1 g/L，p=0.0388）。
在我们的创伤队列中，BMI 似乎显著影响入院时的纤维蛋白原水平。这一结果引起了我们对可能存在的止血过程差异的关注，进而可能导致肥胖创伤患者管理中不同的诊断和治疗阈值。中度低纤维蛋白原血症会增加输血风险，并且除了 ISS 之外，还可能是多发伤后早期 MOF 的预后因素。
