Ren Bingkui, Zhang Yuping, Chen Siying, Dai Jinglong, Chong Junci, Chang Zhigang
Department of Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China.
Eur J Trauma Emerg Surg. 2025 May 23;51(1):219. doi: 10.1007/s00068-025-02886-8.
Severe bleeding is a leading cause of ICU admission and mortality. Fibrinogen plays a crucial role in prognosis, yet optimal thresholds and supplementation targets remain unclear.
Patients with major bleeding were extracted from the MIMIC-IV database. Restricted cubic splines (RCS) identified the optimal pre-treatment fibrinogen threshold, and propensity score matching adjusted for confounders. Multiple analytical methods, including multivariable regression and machine learning models, were applied. Post-treatment fibrinogen levels were stratified based on guideline recommendations, and Cox regression assessed survival outcomes.
Among 7,063 patients (6,666 survivors, 397 non-survivors), RCS analysis revealed a nonlinear relationship between pre-treatment fibrinogen and ICU mortality (P-non-linear < 0.001), with a threshold at 1.3 g/L. Patients with Fib > 1.3 g/L had a significant 28-day survival benefit (OR = 0.65, 95% CI: 0.48-0.87, p < 0.01). Post-treatment stratification showed that fibrinogen ≥ 1.3 g/L was associated with improved survival (p < 0.01). RCS analysis identified an optimal post-treatment target of 2.0-2.5 g/L.
Fibrinogen levels are predictive of ICU outcomes in massive hemorrhage. A pre-treatment threshold of 1.3 g/L indicates poor prognosis, while post-treatment levels of 2.0-2.5 g/L may optimize survival.
严重出血是重症监护病房（ICU）收治和死亡的主要原因。纤维蛋白原在预后中起关键作用，但最佳阈值和补充目标仍不明确。
从MIMIC-IV数据库中提取大出血患者。采用限制立方样条（RCS）确定最佳治疗前纤维蛋白原阈值，并通过倾向评分匹配对混杂因素进行调整。应用了多种分析方法，包括多变量回归和机器学习模型。根据指南建议对治疗后纤维蛋白原水平进行分层，并通过Cox回归评估生存结局。
在7063例患者（6666例幸存者，397例非幸存者）中，RCS分析显示治疗前纤维蛋白原与ICU死亡率之间存在非线性关系（P-非线性<0.001），阈值为1.3g/L。纤维蛋白原>1.3g/L的患者有显著的28天生存获益（OR=0.65，95%CI：0.48-0.87，p<0.01）。治疗后分层显示，纤维蛋白原≥1.3g/L与生存改善相关（p<0.01）。RCS分析确定最佳治疗后目标为2.0-2.5g/L。
纤维蛋白原水平可预测大出血患者的ICU结局。治疗前阈值1.3g/L提示预后不良，而治疗后水平2.0-2.5g/L可能优化生存。
