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Observational Study
. 2018 Jul 9;26(1):55.
doi: 10.1186/s13049-018-0523-0.

Modelling the association between fibrinogen concentration on admission and mortality in patients with massive transfusion after severe trauma: an analysis of a large regional database

Pierre Bouzat  1   2   3 , François-Xavier Ageron  4   5 , Jonathan Charbit  6 , Xavier Bobbia  7 , Pauline Deras  6 , Jennifer Bas Dit Nugues  8 , Etienne Escudier  5 , Guillaume Marcotte  9 , Marc Leone  10 , Jean-Stéphane David  11   12
Affiliations
Observational Study

Modelling the association between fibrinogen concentration on admission and mortality in patients with massive transfusion after severe trauma: an analysis of a large regional database

Pierre Bouzat et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: The relationship between fibrinogen concentration and traumatic death has been poorly explored after severe trauma. Existing studies analysed this relationship in unselected trauma population, often considering fibrinogen concentration as a categorical variable. The aim of our study was to model the relationship between fibrinogen concentration and in-hospital mortality in severe trauma patients requiring massive transfusion using fibrinogen on admission as a continuous variable.

Methods: We designed a retrospective observational study based on prospectively collected data from 2009 to 2015 in seven French level-I trauma centres. All consecutive patients requiring a transfusion of at least 10 packed red blood cells (RBC) within 24 h were included. To assess the relationship between in-hospital death and fibrinogen concentration on admission, we performed generalized linear and additive models with death as a dependent variable. We also assessed the relationship between fibrinogen concentration below 1.5 g.L- 1 and potential predictors.

Results: Within the study period, 366 patients were included. A non-linear relationship was found between fibrinogen concentration and death. Graphical modelling of this relationship depicted a negative association between fibrinogen levels and death below a fibrinogen concentration of 1.5 g.L- 1. Predictors of low fibrinogen concentration (< 1.5 g.L- 1) were systolic blood pressure, Glasgow coma scale and haemoglobin concentration on admission.

Conclusions: A complex and robust approach for modelling the relationship between fibrinogen and mortality revealed a critical fibrinogen threshold of 1.5 g.L- 1 for severe trauma patients requiring massive transfusion. This trigger may guide the administration of procoagulant therapies in this context.

Keywords: Fibrinogen; Massive transfusion; Mortality; Severe trauma.

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Conflict of interest statement

Ethics approval and consent to participate

The design of the study received ethical approval by the French Society of Anaesthesiology and Intensive care (IRB number: CERAR 00010254–2017-052). According to the French law No. 2012–300 (Decree No. 2016–1537), non-opposition of surviving patients was obtained by an information letter, and the declaration was made to the French Data Protection Authority.

Consent for publication

Not applicable.

Competing interests

PB, GM and JSD received salaries for lectures from LFB industry, Les Ullis, France.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig. 2
Fig. 2
Modelling risk of death according to fibrinogen concentration: a. Generalized linear model (GLM) and b. Generalized additive model (GAM). Footnotes Fig. 2 (a) Mixed-Generalized Linear Model (GLM) with random effect on trauma center. Polynomial regression including quadratic and cubic terms. P value for linear term = 0.002; N = 363; C-stat = 0.62, Brier = 0.23; Predicted risk of death lowest value for fibrinogen concentration of 1.50 (b) Mixed-Generalized Additive Model (GAM) with random effect on trauma center and 6 equivalent degree of freedom (P value = 0.008). N = 363; Predicted risk of death lowest value for fibrinogen concentration of 1.31
Fig. 3
Fig. 3
Predictors of low fibrinogen concentration in the generalized linear model (GLM). Each graph represents the relationship between a predictor (systolic blood pressure, heart rate, Glasgow coma scale and haemoglobin) and the odds of fibrinogen concentration < 1.5 g.L− 1. Footnotes Fig. 3 Mixed-Generalized Linear Model with random effect on trauma center; N = 362, C-stat = 0.75 95%CI (0.69–0.81), Brier score = 0.19
See this image and copyright information in PMC

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