Richards Justin, Fedeles Benjamin T, Chow Jonathan H, Scalea Thomas, Kozar Rosemary
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
Trauma Surg Acute Care Open. 2023 Jan 25;8(1):e000937. doi: 10.1136/tsaco-2022-000937. eCollection 2023.
Fibrinogen depletion may occur at higher levels than historically referenced. We evaluated hypofibrinogenemia and associated mortality and multiple organ failure (MOF) after severe injury.
Retrospective investigation including 417 adult patients with Injury Severity Score (ISS) >15. Demographics and injury characteristics were collected. Fibrinogen within 30 minutes of admission was described: <150 mg/dL, 150 mg/dL to 200 mg/dL and >200 mg/dL. Primary outcome: 28-day mortality. Secondary outcomes: 28-day MOF and blood product transfusion. Multivariable logistic regression model evaluated association of fibrinogen categories on risk of death, after controlling for confounding variables. Results presented as OR and 95% CIs.
Fibrinogen <150 mg/dL: 4.8%, 150 mg/dL to 200 mg/dL: 18.2%, >200 mg/dL: 77.0%. 28-day mortality: 15.6%. Patients with <150 mg/dL fibrinogen had over fourfold increased 28-day mortality risk (OR: 4.9, 95% CI 1.53 to 15.7) after adjusting for age, ISS and admission Glasgow Coma Scale. Patients with lower fibrinogen were more likely to develop MOF (p=0.04) and receive larger red blood cell transfusion volumes at 3 hours and 24 hours (p<0.01).
Fibrinogen <150 mg/dL is significantly associated with increased 28-day mortality. Patients with fibrinogen <150 mg/dL were more likely to develop MOF and required increased administration of blood products. The optimal threshold for critically low fibrinogen, the association with MOF and subsequent fibrinogen replacement requires further investigation.
Level III.
纤维蛋白原水平降低可能比以往报道的更为常见。我们评估了严重创伤后低纤维蛋白原血症及其相关死亡率和多器官功能衰竭（MOF）情况。
回顾性研究纳入417例损伤严重程度评分（ISS）>15的成年患者。收集人口统计学和损伤特征。记录入院30分钟内的纤维蛋白原水平：<150mg/dL、150mg/dL至200mg/dL和>200mg/dL。主要结局：28天死亡率。次要结局：28天MOF和血液制品输注。多变量逻辑回归模型在控制混杂变量后评估纤维蛋白原类别与死亡风险的关联。结果以比值比（OR）和95%可信区间（CI）表示。
纤维蛋白原<150mg/dL者占4.8%，150mg/dL至200mg/dL者占18.2%，>200mg/dL者占77.0%。28天死亡率为15.6%。在调整年龄、ISS和入院时格拉斯哥昏迷量表后，纤维蛋白原<150mg/dL的患者28天死亡风险增加四倍多（OR：4.9，95%CI 1.53至15.7）。纤维蛋白原水平较低的患者更易发生MOF（p=0.04），且在3小时和24小时接受更大体积的红细胞输注（p<0.01）。
纤维蛋白原<150mg/dL与28天死亡率显著增加相关。纤维蛋白原<150mg/dL的患者更易发生MOF，且需要增加血液制品的输注量。极低纤维蛋白原的最佳阈值、与MOF的关联以及后续纤维蛋白原替代治疗需要进一步研究。
III级
