Abstract
BackgroundIn severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L−1, but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L−1 or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h.MethodsProspective analysis of retrospectively collected data from a trauma registry (01/2011–12/2019). MFD-C was defined by a fibrinogenemia 1.51–1.99 g L−1 or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L−1 (HemoCue®), and base deficit > 5 mEq L−1. Data are expressed as count (%), median [IQR].Results1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19–36] vs. 24 [17–29]) and had more impaired vital signs (base deficit: 5.4 [3.6–7.8] vs. 3.8 [2.0–6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L−1 and < 2.0 g L−1, FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L−1, or a base deficit > 5.0 mEq L−1 received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06–1.82] for MFD-C, and 2.17 [1.48–3.19] for MFD-A5. Results were not modified after adjustment on the ISS.ConclusionsWe have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD.
Highlights
Coagulopathy is frequently observed among criticallyinjured patients and is estimated to occur in 20–30% of patients at admission [1,2,3]
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The objective of this study was to describe the characteristics of patients with moderate fibrinogen deficiency at admission, determined using the Clauss technique (MFD-C) or by thromboelastometry (MFD-at 5 min (A5)), and to specify in this group of patients which criteria were associated with the administration of fibrinogen
Summary
Coagulopathy is frequently observed among criticallyinjured patients and is estimated to occur in 20–30% of patients at admission [1,2,3]. For over a decade David et al Scand J Trauma Resusc Emerg Med (2021) 29:174 it has been suggested that viscoelastic techniques (VET) be used to provide a rapid assessment of hemostatic disorders, of which fibrinogen deficit is the most frequently observed [3, 5]. While the use of higher fibrinogen thresholds may help to decrease the bleeding by increasing the clot firmness, it may lead to unnecessary administration of fibrinogen, increased costs or, more importantly, to adverse procoagulant events It is important during the resuscitation of injured patients to define precisely which patients, with a moderate fibrinogen deficit (MFD), will benefit from fibrinogen supplementation. The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h
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