Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma: Analyses of a retrospective multicentre observational study |
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| Affiliation: | 1. Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan;2. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan;3. Academia, Industry and Government Collaborative Research Institute of Translational Medicine for Life Innovation, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan;4. Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan;5. Department of Emergency & Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;6. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan;7. Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku Orai-kita Izumisano, Osaka 598-8577, Japan;8. Department of Emergency and Critical Care Medicine, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan;9. Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho Minami-ku, Yokohama 232-0024, Japan;10. Emergency and Critical Care Center, Hokkaido University Hospital N14W5, Kita-ku, Sapporo 060-8648, Japan;11. Department of Emergency Medicine and Critical Care, National Center For Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan;12. Department of Critical Care and Emergency Medicine, Tokyo Women''s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan;13. Trauma and Emergency Center, Fukaya Red Cross Hospital, 5-8-1 Kamishiba-West, Fukaya, Saitama 366-0052, Japan;14. Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama 359-8513, Japan;15. Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo, Tokyo 113-8510, Japan;p. Department of Emergency & Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo-Ku, Tokyo 113-8603, Japan;q. Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan;r. Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan;1. Monash University, Clayton, Victoria, Australia;2. Monash University, Department of Community Emergency Health and Paramedic Practice, Australia;3. Trauma Service, The Alfred Hospital, Australia;4. Emergency & Trauma Centre, The Alfred Hospital, Australia;5. Department of Epidemiology & Preventive Medicine, Monash University, Australia;6. National Trauma Research Institute, The Alfred Hospital, Australia;7. Ambulance Victoria, Melbourne, Victoria, Australia;1. Intensive Care Unit, Hospital Universitario Rio Hortega, C/Dulzaina 2, 47012 Valladolid, Spain;2. Critical Care Burn Unit, Hospital Universitario Rio Hortega, C/Dulzaina 2, 47012 Valladolid, Spain;3. Plastic Surgery Department, Hospital Universitario Rio Hortega, C/Dulzaina 2, 47012 Valladolid, Spain |
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| Abstract: | IntroductionIn the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma.MethodsWe conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24 h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable.ResultsHigher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10 mm Hg), GCS, and Fbg levels (per 10 mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95% confidence interval [CI] 1.326–1.668; OR 0.851, 95% CI 0.789–0.914; OR 0.907, 95% CI 0.855–0.962; and OR 0.931, 95% CI 0.898–0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4%, specificity 79.8%), ≤120 mm Hg (sensitivity 61.5%, specificity 70.5%), ≤12 points (sensitivity 63.3%, specificity 63.6%), and ≤190 mg/dL (sensitivity 55.1%, specificity 78.6%), respectively.ConclusionsOur findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT. |
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| Keywords: | Heart rate Systolic blood pressure Glasgow coma scale Fibrinogen Massive transfusion Trauma Cut-off value Sensitivity Specificity |
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