Fibrinogen level at admission is associated with 24-hour mortality in polytraumatized adults.

Gareb, B. (2015) Fibrinogen level at admission is associated with 24-hour mortality in polytraumatized adults. thesis, Medicine.

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Abstract

Background Trauma is one of the leading causes of death worldwide. Central nervous system (CNS) injury and hemorrhage are the most common causes of mortality within the first 24 hours after trauma. Hemorrhage is the leading cause of (potentially) preventable death after injury, most often due to delay in treatment. Acute Traumatic Coagulopathy (ATC) is a coagulopathy which results in a hypocoaguable and hyperfibrinolytic state. Fibrinogen is the most vulnerable coagulation factor resulting in a rapid fall in fibrinogen concentration after admission. The objective of this study was to estimate the adjusted effect of fibrinogen level at admission on 24-hour mortality in polytraumatized patients. Additionally, we tried to determine if this relationship is different for sex, age, and traumatic brain injury. Material and methods Patients treated in 2004-2013 at the University Medical Center Groningen with New Injury Severity Score (NISS) higher than 15 and age of 18-80 years were included. Endpoint of this study was mortality within 24 hours after admission. Patient’s characteristics consisted of demographics and initial shock-related and coagulation parameters. For descriptive statistics, patients were divided into two groups based on their outcome: survivors and non-survivors. Multivariable Cox regression model was used to investigate the adjusted effect of fibrinogen level at admission on 24-hour mortality in polytraumatized patients. Results Out of 1491 included patients, 1377 (92.4%) survived and 114 patients (7.6%) died within the first 24 hours after admission. Median age of all subjects was 45 (25th-75th percentile [P25-P75] 28-60). The vast majority of patients were male (76.3%) and had mainly blunt trauma (95.3%). Median Glasgow Coma Scale (GCS) was 13 (P25-P75, 6-15). Median NISS (P25-P75) was 33 (25-43). Mean fibrinogen level (standard deviation) of all patients was 2.0 (1.0). Of all characteristics, sex (P=0.819), cause of injury (P=0.230), mechanism of injury (P=0.134), and pulse (P=0.878) were not significantly different between both subgroups. Multivariable Cox regression analysis showed a significant adjusted effect of fibrinogen level at admission on 24-hour mortality (hazard ratio [HR] 0.475, 95% confidence interval [95% CI] 0.305-0.738; P=0.001). No relevant effect modification was found. Conclusion The present study demonstrates a significant adjusted association between fibrinogen level at admission and 24-hour mortality in polytraumatized adults. This effect of fibrinogen was not modified by sex, age, or traumatic brain injury. Monitoring fibrinogen levels routinely at admission and actively supplementing fibrinogen could reduce (potential) preventable deaths.

Item Type:	Thesis (Thesis)
Supervisor name:	el Moumni, M. MD
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2718

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