Service d'anesthésie-réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France.
Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.
Scand J Trauma Resusc Emerg Med. 2021 Dec 24;29(1):174. doi: 10.1186/s13049-021-00988-x.
In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L, but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h.
Prospective analysis of retrospectively collected data from a trauma registry (01/2011-12/2019). MFD-C was defined by a fibrinogenemia 1.51-1.99 g L or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L (HemoCue®), and base deficit > 5 mEq L. Data are expressed as count (%), median [IQR].
1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19-36] vs. 24 [17-29]) and had more impaired vital signs (base deficit: 5.4 [3.6-7.8] vs. 3.8 [2.0-6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L and < 2.0 g L, FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L, or a base deficit > 5.0 mEq L received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06-1.82] for MFD-C, and 2.17 [1.48-3.19] for MFD-A5. Results were not modified after adjustment on the ISS.
We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD.
在严重创伤患者中，当纤维蛋白原血症 < 1.5 g/L 时，建议补充纤维蛋白原，但有些团队建议使用更高的阈值（纤维蛋白原血症 < 2.0 g/L 或纤维蛋白原功能试验（FIBTEM）5 分钟时的凝血块幅度（A5）值 < 11 mm）。本研究的目的是在有中度纤维蛋白原缺乏症（MFD）的患者中，确定某些入院特征是否与 24 小时内的纤维蛋白原给药有关。
对创伤登记处（2011 年 1 月至 2019 年 12 月）回顾性收集数据的前瞻性分析。MFD-C 通过纤维蛋白原血症 1.51-1.99 g/L 或相应的 FIBTEM-A5 值（MFD-A5）来定义，这是通过线性回归和 ROC 曲线分析确定的。纤维蛋白原的给药情况根据以下入院参数进行描述：休克指数（SI）> 1、血红蛋白水平 < 110 g/L（HemoCue®）和基础缺失值 > 5 mEq/L。数据以计数（%）、中位数[IQR]表示。
本研究共纳入 1076 例患者，其中 266 例（27%）有 MFD-C，其中 122/266 例（46%）接受了纤维蛋白原治疗。接受纤维蛋白原治疗的 MFD-C 患者损伤更严重（ISS：27[19-36] vs. 24[17-29]），生命体征更受损（基础缺失值：5.4[3.6-7.8] vs. 3.8[2.0-6.0]）。线性回归分析发现纤维蛋白原水平与 FIBTEM-A5 呈正相关（r：0.805）。对于纤维蛋白原水平 < 1.5 g/L 和 < 2.0 g/L，FIBTEM-A5 的阈值分别为 6 mm（灵敏度 85%，特异性 83%，AUC：0.934）和 9 mm（灵敏度 84%，特异性 69%，AUC：0.874）。MFD-A5 值（185 例患者）定义为 FIBTEM-A5 为 7-9 mm。超过 50%的有 MFD-C、SI > 1、血红蛋白水平 < 110 g/L 或基础缺失值 > 5.0 mEq/L 的患者接受了纤维蛋白原治疗。纤维蛋白原给药（SI > 1）的相对风险[95%CI]为 MFD-C 时为 1.39[1.06-1.82]，MFD-A5 时为 2.17[1.48-3.19]。调整 ISS 后，结果未发生改变。
本研究表明，休克参数与纤维蛋白原给药之间存在关联。需要进一步研究以确定这些参数如何可用于指导有 MFD 的创伤患者的纤维蛋白原给药。
