Fibrinogen is an independent predictor of mortality in major trauma patients: a five-year statewide cohort study

• Published in: Injury 2017-05, Vol.48 (5), p.1074-1081
• Main Authors: McQuilten, Zoe K, Wood, Erica M, Bailey, Michael, Cameron, Peter A, Cooper, David J
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - blood; Coagulopathy; Cohort Studies; Female; Fibrinogen; Fibrinogen - metabolism; Haemorrhage; Hemorrhage - metabolism; Hemorrhage - mortality; Hospital Mortality; Humans; Injury Severity Score; Logistic Models; Male; Middle Aged; Orthopedics; Practice Guidelines as Topic; Practice Patterns, Physicians; Predictive Value of Tests; Prospective Studies; Risk Factors; Transfusion; Trauma; Trauma Centers; Victoria - epidemiology; Wounds and Injuries - metabolism; Wounds and Injuries - mortality; Wounds and Injuries - physiopathology
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2016.11.021

Abstract Introduction Fibrinogen may be reduced following traumatic injury due to loss from haemorrhage, increased consumption and reduced synthesis. In the absence of clinical trials, guidelines for fibrinogen replacement are based on expert opinion and vary internationally. We aimed to determine prevalence and predictors of low fibrinogen on admission in major trauma patients and investigate association of fibrinogen levels with patient outcomes. Patients and methods Data on all major trauma patients (January 2007–July 2011) identified through a prospective statewide trauma registry in Victoria, Australia were linked with laboratory and transfusion data. Major trauma included any of the following: death after injury, injury severity score (ISS) >15, admission to intensive care unit requiring mechanical ventilation, or urgent surgery for intrathoracic, intracranial, intra-abdominal procedures or fixation of pelvic or spinal fractures. Associations between initial fibrinogen level and in-hospital mortality were analysed using multiple logistic regression. Results Of 4773 patients identified, 114 (2.4%) had fibrinogen less than 1 g/L, 283 (5.9%) 1.0–1.5 g/L, 617 (12.9%) 1.6–1.9 g/L, 3024 (63.4%) 2–4 g/L and 735 (15%) >4 g/L. Median fibrinogen was 2.6 g/L (interquartile range 2.1–3.4). After adjusting for age, gender, ISS, injury type, pH, temperature, Glasgow Coma Score (GCS), initial international normalised ratio and platelet count, the lowest fibrinogen categories, compared with normal range, were associated with increased in-hospital mortality (adjusted odds ratio [OR] for less than 1 g/L 3.28 [95% CI 1.71–6.28, p < 0.01], 1–1.5 g/L adjusted OR 2.08 [95% CI 1.36–3.16, p < 0.01] and 1.6–1.9 g/L adjusted OR 1.39 [95% CI 0.97–2.00, p = 0.08]). Predictors of initial fibrinogen