Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis

Abstract

Background Fibrinogen plays an important role in haemostasis during the early phase of trauma, and low fibrinogen levels after severe trauma are associated with haemostatic impairment, massive bleeding, and poor outcomes. Aggressive fibrinogen supplementation may improve haemostatic function, as fibrinogen levels deteriorate before other routine coagulation parameters in this setting. Therefore, we evaluated whether early administration of fibrinogen concentrate (FC) was associated with improved survival in severe trauma patients. Methods This single-centre retrospective study evaluated patients with severe trauma (injury severity score ≥ 16) who were admitted to our emergency department between January 2010 and July 2018. The exclusion criteria included age < 18 years, cardiac arrest before emergency department arrival, cervical spinal cord injury not caused by a high-energy accident, and severe burn injuries. The FC and control groups included trauma patients who received and did not receive FC within 1 h after emergency department arrival, respectively. Propensity scores were used to balance the two groups based on the trauma and injury severity score (TRISS), heart rate at emergency department admission, and age. The primary outcome was the in-hospital survival rate. Results The propensity scoring model had a c-statistic of 0.734, the Hosmer-Lemeshow chi-squared value was 7.036 (degrees of freedom = 8), and the non-significant p value of 0.533 indicated a good model fit. The propensity score matching created 31 matched pairs of patients, who had appropriately balanced characteristics. The FC group had a significantly higher in-hospital survival rate than the control group (log-rank p = 0.013). The FC group also used significantly higher amounts of red blood cells and fresh frozen plasma within 6 h after emergency department admission. However, the two groups had similar transfusion amounts between 6 and 24 h after emergency department admission. Conclusions The present study revealed that early FC administration was associated with a favourable survival rate among severe trauma patients. Therefore, FC may be useful for the early management of trauma-induced coagulopathy and may improve outcomes in this setting.

Trauma-induced coagulopathy

“…Of note, these improved outcomes are limited to patients with traumatic injury undergoing a massive transfusion, and there is evidence that patients with traumatic injury who do not receive a massive transfusion may be harmed by these protocols. High ratios of fibrinogen or cryoprecipitate to RBCs have also been advocated to decrease trauma mortality 273 , but the results of ongoing RCTs are awaited before this approach can be recommended. If empirical ratios of plasma to RBCs are used to resuscitate massively bleeding patients, cryoprecipitate or fibrinogen and platelets should be administered if the patient requires >4 units of RBCs before laboratory results are available 213 .…”

Effects of pathogen reduction technology and storage duration on the ability of cryoprecipitate to rescue induced coagulopathies in vitro

“…Mortality at 28 days is high in patients with severe traumatic hemorrhage, ranging between 20% and 24% in adults 1,2 and 36% and 50% in children 3,4 . Impaired fibrinogen function is highly associated with mortality in these patients with traumatic bleeding, 5,6 and transfusion of fibrinogen‐containing products may improve outcomes 7–10 . Currently, there are two sources of exogenous fibrinogen used during resuscitation: fibrinogen concentrates and cryoprecipitate.…”

Prognostic Value of Critical Laboratory Values in Burn Patients: a Retrospective Observational Study

“…Decreased brinogen levels on admission of trauma patients were associated with adverse outcomes [29]. The low brinogen levels that lead to poor outcomes after severe trauma may be due to impaired haemostasis and subsequent heavy bleeding [30]. It has also been con rmed that diffuse intravascular coagulation scores increase with decreasing plasma brinogen levels [31].…”

“…The details were as follows: hypertroponinemia (54), alkalemia (50), PBC (38), acidaemia (31), hypocapnia (30), hypercapnia (20), hypocalcaemia (20), hypoxemia (18), hyperglycaemia (15), high APPT (14), hypokalaemia (13), hypernatremia (11), hypo brinogenemia (9), hypohemoglobinemia (9), hyperkalaemia (9), hypoglycaemia (6), hypothrombosis (5), and high PT (4).…”