钝性创伤性脑损伤患者入院时纤维蛋白原水平的临床意义：一项回顾性观察研究
Clinical Significance of On-Admission Fibrinogen Levels in Patients With Blunt Traumatic Brain Injury: A Retrospective Observational Study.
作者信息
Peralta Ruben, Mekkodathil Ahammed, El-Menyar Ayman, Consunji Rafael, Ramzee Ahmed F, Musa Mosaab A, Abdel-Aziz Bahey Ahmed, Al-Thani Hassan, Rizoli Sandro
机构信息
Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar.
Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic.
出版信息
World J Surg. 2025 Jun;49(6):1665-1675. doi: 10.1002/wjs.12617. Epub 2025 May 7.
BACKGROUND
Traumatic brain injury (TBI) is a major cause of morbidity and disability, which may be complicated by coagulation disturbances that exacerbate intracranial bleeding and worsen patient outcomes. Fibrinogen is a critical coagulation factor that is often depleted early following severe TBI. We aimed to explore the relationship between admission serum fibrinogen levels in patients with traumatic brain injury (TBI) and mortality.
METHODS
A retrospective analysis was conducted for patients with TBI admitted between 2016 and 2021. Comparative analyses based on on-admission serum fibrinogen levels (< 1.0 (critical low), 1.0-1.5 (low), and > 1.5 g/L) were performed. A multivariable regression analysis was carried out to predict mortality.
RESULTS
A total of 804 patients were included. Most patients were young males and were involved in motor vehicle crashes (60%) or falls (24%). The median fibrinogen level was 2.3 (IQR 1.8-2.9) and 1.9 (IQR 1.5-2.5) g/L in isolated (23%) and polytrauma TBI (77%), respectively. Fibrinogen therapy was administrated to 145 patients (in patients with fibrinogen levels ≤ 1.5). The most prevalent TBI lesions were subarachnoid hemorrhage (43%) and subdural hematoma (35%). The median Injury Severity Score (ISS) was 27 (interquartile range 19-34) and 75.7% had severe TBI. Hypofibrinogenemia was found in 26.5% of cases and was correlated with MTP and the severity of TBI. Fibrinogen therapy was given in 18% of the cohort (88% and 61% of the critical low and low fibrinogen group, respectively). The overall mortality rate was 21.8%. Mortality rates begin to rise at fibrinogen levels below 1.5 g/L, increasing by 263% at levels 1.0-1.5 g/L and by 630% at levels lower than 1.0 g/L (p < 0.05). The critical low level was an independent predictor of mortality (odds ratio 4.03 and 95% confidence interval 1.44-11.27) after adjustment for age, GCS, shock index, Injury Severity Score, fibrinogen therapy, serum lactate, and positive Focused Assessment with Sonography in Trauma.
CONCLUSION
This study demonstrates an association between admission serum fibrinogen levels and mortality in blunt polytrauma patients with TBI.
背景
创伤性脑损伤（TBI）是发病和致残的主要原因，可能并发凝血功能障碍，从而加重颅内出血并使患者预后恶化。纤维蛋白原是一种关键的凝血因子，在重度TBI后常早期耗竭。我们旨在探讨创伤性脑损伤（TBI）患者入院时血清纤维蛋白原水平与死亡率之间的关系。
方法
对2016年至2021年期间收治的TBI患者进行回顾性分析。根据入院时血清纤维蛋白原水平（<1.0（极低）、1.0 - 1.5（低）和>1.5 g/L）进行比较分析。进行多变量回归分析以预测死亡率。
结果
共纳入804例患者。大多数患者为年轻男性，因机动车事故（60%）或跌倒（24%）受伤。单纯性（23%）和多发性创伤性TBI（77%）患者的纤维蛋白原水平中位数分别为2.3（IQR 1.8 - 2.9）和1.9（IQR 1.5 - 2.5）g/L。145例患者（纤维蛋白原水平≤1.5的患者）接受了纤维蛋白原治疗。最常见的TBI损伤为蛛网膜下腔出血（43%）和硬膜下血肿（35%）。损伤严重程度评分（ISS）中位数为27（四分位间距19 - 34），75.7%的患者为重度TBI。26.5%的病例存在低纤维蛋白原血症，且与大量输血方案及TBI严重程度相关。18%的队列接受了纤维蛋白原治疗（极低和低纤维蛋白原组分别为88%和61%）。总死亡率为21.8%。纤维蛋白原水平低于1.5 g/L时死亡率开始上升，在1.0 - 1.5 g/L时增加263%，在低于1.0 g/L时增加630%（p < 0.05）。在调整年龄、格拉斯哥昏迷评分、休克指数、损伤严重程度评分、纤维蛋白原治疗、血清乳酸以及创伤重点超声评估阳性结果后，极低水平是死亡率的独立预测因素（比值比4.03，95%置信区间1.44 - 11.27）。
结论
本研究表明钝性多发性创伤性TBI患者入院时血清纤维蛋白原水平与死亡率之间存在关联。
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