Fibrinogen and base excess levels as predictive markers of the need for massive blood transfusion after blunt trauma.

Takehiro Umemura,Yoshihiko Nakamura,Kota Hoshino,Takeshi Nishida,Hiroyasu Ishikura

doi:10.1007/s00595-015-1263-7

Takehiro Umemura, Yoshihiko Nakamura + Show 3 more

Open Access

https://doi.org/10.1007/s00595-015-1263-7

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Journal: Surgery today	Publication Date: Nov 3, 2015
Citations: 57	License type: CC BY 4.0

Affiliation: Fukuoka University

Abstract

BackgroundAssessment blood consumption and trauma-associated severe hemorrhage scores are useful for predicting the need for massive transfusion (MT) in severe trauma patients. However, fibrinogen (Fbg) and base excess (BE) levels might also be useful indicators for the need for MT. We evaluated the accuracy of prediction for MT of the scoring system vs. Fbg and BE.MethodsThe subjects of this retrospective single center observational study were patients with injury severity score ≥16 trauma, divided into a non-MT group and an MT group. We compared variables, including the scoring system (comprising vital signs and focused assessment with sonography for trauma; FAST) and Fbg between the groups. We then performed a multiple logistic regression modeling and a receiver operating characteristic analysis to clarify which value was the most useful predictive indicator for MT.ResultsThere were 114 patients in the non-MT group and 39 in the MT group. The level of Fbg and BE were independent predictors of MT. The area under the curve values for Fbg and BE were 0.765 and 0.845, respectively, and the optimal cutoff values of Fbg and BE were 211 mg/dL and −1.4, respectively.ConclusionsFbg and BE levels can be used as an independent predictor for MT.

Highlights

Trauma is a leading cause of death in persons under the age of 40 and severe hemorrhage is a major cause of mortality in both civilian and military trauma [1,2,3]
Three patients who we included in the massive transfusion (MT) group were transfused with less than 10 units of PRBCs but died of uncontrolled massive bleeding within 24 h
The ratio of male patients as well as systolic blood pressure (SBP), Hb, base excess (BE), and Fbg levels were significantly lower in the MT group

Summary

Introduction

Trauma is a leading cause of death in persons under the age of 40 and severe hemorrhage is a major cause of mortality in both civilian and military trauma [1,2,3]. There are few simple criteria to predict the need for a massive transfusion (MT) in severe trauma patients. The assessment blood consumption (ABC) [9] and trauma-associated severe hemorrhage (TASH) [10] scoring systems are useful predictors of the need for MT. These scoring systems require the assessment of several factors, such as vital signs, focused assessment with sonography for trauma (FAST), pelvic fracture and/or femur fracture, making them slightly complicated. Assessment blood consumption and traumaassociated severe hemorrhage scores are useful for predicting the need for massive transfusion (MT) in severe trauma patients.

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