Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA.
Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231175089. doi: 10.1177/10760296231175089.
This study aims to investigate the ability of fibrinogen and rotational thromboelastometry (ROTEM) parameters measured at obstetric hemorrhage protocol initiation to predict severe hemorrhage.
In this retrospective study we included patients whose hemorrhage was managed with an obstetric massive transfusion protocol. Fibrinogen and ROTEM parameters EXTEM clotting time (CT), clot formation time (CFT), alpha angle, A10, A20, lysis index 30 min after CT (LI30), FIBTEM A10, A20, were measured at initiation of the protocol with transfusion based on a predefined algorithm. Patients were grouped into either severe or nonsevere hemorrhage based on: peripartum fall in hemoglobin ≥4 g/dL, transfusion of ≥4 units of blood product, invasive procedures for hemorrhage control, intensive care unit admission, or death.
Of the 155 patients included, 108 (70%) progressed to severe hemorrhage. Fibrinogen, EXTEM alpha angle, A10, A20, FIBTEM A10, A20 were significantly lower in the severe hemorrhage group while the CFT was significantly prolonged in the severe hemorrhage group. In univariate analysis, predicted progression to severe hemorrhage yielded areas under the receiver operating characteristic curve (95% confidence interval [CI]) of: fibrinogen: 0.683 (0.591-0.776), CFT: 0.671 (0.553, 0.789), EXTEM alpha angle: 0.690 (0.577-0.803), A10: 0.693 (0.570-0.815), A20: 0.678 (0.563-0.793), FIBTEM A10: 0.726 (0.605-0.847), and A20: 0.709 (0.594-0.824). In a multivariable model, fibrinogen was independently associated with severe hemorrhage (odds ratio [95% CI] = 1.037 [1.009-1.066]) for every 50 mg/dL decrease in fibrinogen drawn at obstetric hemorrhage massive transfusion protocol initiation.
Both fibrinogen and ROTEM parameters measured at the initiation of an obstetric hemorrhage protocol are useful parameters for predicting severe hemorrhage.
本研究旨在探讨在产科大出血方案启动时测量的纤维蛋白原和旋转血栓弹性测定（ROTEM）参数预测严重出血的能力。
在这项回顾性研究中，我们纳入了接受产科大出血方案治疗的患者。在方案启动时，根据预设的算法，通过输血来测量纤维蛋白原和 ROTEM 参数 EXTEM 凝血时间（CT）、凝血形成时间（CFT）、α角、A10、A20、CT 后 30 分钟的溶解指数（LI30）、FIBTEM A10、A20。根据围产期血红蛋白下降≥4g/dL、输血≥4 个单位的血制品、控制出血的有创操作、入住重症监护病房或死亡，将患者分为严重出血或非严重出血组。
在纳入的 155 例患者中，108 例（70%）进展为严重出血。严重出血组的纤维蛋白原、EXTEM α角、A10、A20、FIBTEM A10、A20 明显降低，而 CFT 明显延长。在单因素分析中，预测严重出血进展的受试者工作特征曲线下面积（95%置信区间[CI]）为：纤维蛋白原：0.683（0.591-0.776），CFT：0.671（0.553-0.789），EXTEM α角：0.690（0.577-0.803），A10：0.693（0.570-0.815），A20：0.678（0.563-0.793），FIBTEM A10：0.726（0.605-0.847），A20：0.709（0.594-0.824）。在多变量模型中，纤维蛋白原与严重出血独立相关（比值比[95%CI] = 1.037[1.009-1.066]），每降低 50mg/dL 纤维蛋白原，发生严重出血的风险增加 1.037 倍。
在产科大出血方案启动时测量的纤维蛋白原和 ROTEM 参数均是预测严重出血的有用参数。
