Fibrinogen level at hospital admission after multiple injury correlates with BMI and is negatively associated with the need for transfusion and early multiple organ failure

Abstract

IntroductionBleeding and coagulopathy are leading causes of morbidity and lethal outcome after multiple injuries. The pathophysiology of traumatic coagulopathy is under extensive investigations and recent results highlighted the central role of fibrinogen and the fibrin polymerisation process. Our goal was to investigate the factors influencing fibrinogen level and the consequences of hypofibrinogenaemia with clinical importance. MethodsWe conducted a retrospective analysis enrolling adult patients admitted to the shock room of a tertiary trauma centre in Hungary. Beside coagulation values, demographic data, injury related, transfusion and outcome parameters were collected from the hospital electronic charts. Only patients with complete e-chart were involved into final analysis. Multivariate linear and proportional odds logistic regression models were used to model outcomes – admission fibrinogen and SOFA score – controlling for age, sex, BMI, ISS and lactic acidosis. Results54 patients were enrolled in final analysis. Among the parameters analysed, BMI was positively associated with fibrinogen level at admission (+0.23 g/l for every 5 unit of increase in BMI, 95% CI: 0.09-0.37, p=0.0021). Increased risk of transfusion was observed, if fibrinogen at admission was about 1.8 g/l or lower. Beside age and ISS, fibrinogen concentration was also a determinant of early organ failures as it negatively correlated with SOFA scores within 24 hours or care (OR=2.42, 95% CI: 1.05-5.62, for 1 g/l decrease, p=0.0388). ConclusionsIn our trauma cohort BMI seems to significantly influence fibrinogen level at admission. This result draws our attention to the possible differences of haemostasis process, and consequently different diagnostic and therapeutic thresholds in the management of obese trauma patients. Moderate hypofibrinogenaemia increases transfusion risk and beside ISS might be a prognostic factor of early MOF after multiple injuries.