Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion

Kenji Inaba, Efstathios Karamanos, Thomas Lustenberger, Herbert Schöchl, Ira Shulman, Janice Nelson, Peter M Rhee, Peep Talving, Lydia Lam, Demetrios Demetriades

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background: For critically injured patients requiring a massive transfusion, the optimal plasma fibrinogen level is unknown. The purpose of this study was to examine the impact of the fibrinogen level on mortality. We hypothesized that decreasing fibrinogen levels are associated with worse outcomes. Study Design: All patients undergoing a massive transfusion from January 2000 through December 2011 were retrospectively identified. Those with a fibrinogen level measured on admission to the surgical ICU were analyzed according to their fibrinogen level (normal [≥180 mg/dL], abnormal [≥101 to <180 mg/dL], and critical [≤100 mg/dL]). Primary outcome was death. Multivariate analysis evaluated the impact of fibrinogen on survival. Results: There were 260 patients who met inclusion criteria. Ninety-two patients had normal admission fibrinogen levels, 114 had abnormal levels, and 54 patients had critical levels. Patients with a critical fibrinogen level had significantly higher mortality at 24 hours compared with patients with abnormal (31.5% vs 5.3%; adj. p < 0.001) and normal fibrinogen levels (31.5% vs 4.3%; adjusted p < 0.001). Patients with a critical fibrinogen level had significantly higher in-hospital mortality compared with patients with abnormal (51.9% vs 25.4%; adjusted p = 0.013) and normal fibrinogen levels (51.9% vs 18.5%; adjusted p < 0.001). A critical fibrinogen level was the most important independent predictor of mortality (p = 0.012). Conclusions: For patients undergoing a massive transfusion after injury, as the fibrinogen level increased, a stepwise improvement in survival was noted. A fibrinogen level ≤100 mg/dL was a strong independent risk factor for death. The impact of an aggressive fibrinogen replacement strategy using readily available products warrants further prospective evaluation.

Original languageEnglish (US)
Pages (from-to)290-297
Number of pages8
JournalJournal of the American College of Surgeons
Volume216
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

Fingerprint

Fibrinogen
Wounds and Injuries
Mortality
Survival
Hospital Mortality
Multivariate Analysis

Keywords

  • Abbreviated Injury Score
  • activated prothrombin time
  • AIS
  • aPTT
  • GCS
  • Glasgow Coma Scale
  • Injury Severity Score
  • INR
  • international normalized ratio
  • ISS
  • odds ratio
  • OR
  • prothrombin time
  • PT
  • SICU
  • surgical ICU

ASJC Scopus subject areas

  • Surgery

Cite this

Inaba, K., Karamanos, E., Lustenberger, T., Schöchl, H., Shulman, I., Nelson, J., ... Demetriades, D. (2013). Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. Journal of the American College of Surgeons, 216(2), 290-297. https://doi.org/10.1016/j.jamcollsurg.2012.10.017

Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. / Inaba, Kenji; Karamanos, Efstathios; Lustenberger, Thomas; Schöchl, Herbert; Shulman, Ira; Nelson, Janice; Rhee, Peter M; Talving, Peep; Lam, Lydia; Demetriades, Demetrios.

In: Journal of the American College of Surgeons, Vol. 216, No. 2, 02.2013, p. 290-297.

Research output: Contribution to journalArticle

Inaba, K, Karamanos, E, Lustenberger, T, Schöchl, H, Shulman, I, Nelson, J, Rhee, PM, Talving, P, Lam, L & Demetriades, D 2013, 'Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion', Journal of the American College of Surgeons, vol. 216, no. 2, pp. 290-297. https://doi.org/10.1016/j.jamcollsurg.2012.10.017
Inaba, Kenji ; Karamanos, Efstathios ; Lustenberger, Thomas ; Schöchl, Herbert ; Shulman, Ira ; Nelson, Janice ; Rhee, Peter M ; Talving, Peep ; Lam, Lydia ; Demetriades, Demetrios. / Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 2. pp. 290-297.
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abstract = "Background: For critically injured patients requiring a massive transfusion, the optimal plasma fibrinogen level is unknown. The purpose of this study was to examine the impact of the fibrinogen level on mortality. We hypothesized that decreasing fibrinogen levels are associated with worse outcomes. Study Design: All patients undergoing a massive transfusion from January 2000 through December 2011 were retrospectively identified. Those with a fibrinogen level measured on admission to the surgical ICU were analyzed according to their fibrinogen level (normal [≥180 mg/dL], abnormal [≥101 to <180 mg/dL], and critical [≤100 mg/dL]). Primary outcome was death. Multivariate analysis evaluated the impact of fibrinogen on survival. Results: There were 260 patients who met inclusion criteria. Ninety-two patients had normal admission fibrinogen levels, 114 had abnormal levels, and 54 patients had critical levels. Patients with a critical fibrinogen level had significantly higher mortality at 24 hours compared with patients with abnormal (31.5{\%} vs 5.3{\%}; adj. p < 0.001) and normal fibrinogen levels (31.5{\%} vs 4.3{\%}; adjusted p < 0.001). Patients with a critical fibrinogen level had significantly higher in-hospital mortality compared with patients with abnormal (51.9{\%} vs 25.4{\%}; adjusted p = 0.013) and normal fibrinogen levels (51.9{\%} vs 18.5{\%}; adjusted p < 0.001). A critical fibrinogen level was the most important independent predictor of mortality (p = 0.012). Conclusions: For patients undergoing a massive transfusion after injury, as the fibrinogen level increased, a stepwise improvement in survival was noted. A fibrinogen level ≤100 mg/dL was a strong independent risk factor for death. The impact of an aggressive fibrinogen replacement strategy using readily available products warrants further prospective evaluation.",
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AU - Inaba, Kenji

AU - Karamanos, Efstathios

AU - Lustenberger, Thomas

AU - Schöchl, Herbert

AU - Shulman, Ira

AU - Nelson, Janice

AU - Rhee, Peter M

AU - Talving, Peep

AU - Lam, Lydia

AU - Demetriades, Demetrios

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N2 - Background: For critically injured patients requiring a massive transfusion, the optimal plasma fibrinogen level is unknown. The purpose of this study was to examine the impact of the fibrinogen level on mortality. We hypothesized that decreasing fibrinogen levels are associated with worse outcomes. Study Design: All patients undergoing a massive transfusion from January 2000 through December 2011 were retrospectively identified. Those with a fibrinogen level measured on admission to the surgical ICU were analyzed according to their fibrinogen level (normal [≥180 mg/dL], abnormal [≥101 to <180 mg/dL], and critical [≤100 mg/dL]). Primary outcome was death. Multivariate analysis evaluated the impact of fibrinogen on survival. Results: There were 260 patients who met inclusion criteria. Ninety-two patients had normal admission fibrinogen levels, 114 had abnormal levels, and 54 patients had critical levels. Patients with a critical fibrinogen level had significantly higher mortality at 24 hours compared with patients with abnormal (31.5% vs 5.3%; adj. p < 0.001) and normal fibrinogen levels (31.5% vs 4.3%; adjusted p < 0.001). Patients with a critical fibrinogen level had significantly higher in-hospital mortality compared with patients with abnormal (51.9% vs 25.4%; adjusted p = 0.013) and normal fibrinogen levels (51.9% vs 18.5%; adjusted p < 0.001). A critical fibrinogen level was the most important independent predictor of mortality (p = 0.012). Conclusions: For patients undergoing a massive transfusion after injury, as the fibrinogen level increased, a stepwise improvement in survival was noted. A fibrinogen level ≤100 mg/dL was a strong independent risk factor for death. The impact of an aggressive fibrinogen replacement strategy using readily available products warrants further prospective evaluation.

AB - Background: For critically injured patients requiring a massive transfusion, the optimal plasma fibrinogen level is unknown. The purpose of this study was to examine the impact of the fibrinogen level on mortality. We hypothesized that decreasing fibrinogen levels are associated with worse outcomes. Study Design: All patients undergoing a massive transfusion from January 2000 through December 2011 were retrospectively identified. Those with a fibrinogen level measured on admission to the surgical ICU were analyzed according to their fibrinogen level (normal [≥180 mg/dL], abnormal [≥101 to <180 mg/dL], and critical [≤100 mg/dL]). Primary outcome was death. Multivariate analysis evaluated the impact of fibrinogen on survival. Results: There were 260 patients who met inclusion criteria. Ninety-two patients had normal admission fibrinogen levels, 114 had abnormal levels, and 54 patients had critical levels. Patients with a critical fibrinogen level had significantly higher mortality at 24 hours compared with patients with abnormal (31.5% vs 5.3%; adj. p < 0.001) and normal fibrinogen levels (31.5% vs 4.3%; adjusted p < 0.001). Patients with a critical fibrinogen level had significantly higher in-hospital mortality compared with patients with abnormal (51.9% vs 25.4%; adjusted p = 0.013) and normal fibrinogen levels (51.9% vs 18.5%; adjusted p < 0.001). A critical fibrinogen level was the most important independent predictor of mortality (p = 0.012). Conclusions: For patients undergoing a massive transfusion after injury, as the fibrinogen level increased, a stepwise improvement in survival was noted. A fibrinogen level ≤100 mg/dL was a strong independent risk factor for death. The impact of an aggressive fibrinogen replacement strategy using readily available products warrants further prospective evaluation.

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KW - aPTT

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KW - Injury Severity Score

KW - INR

KW - international normalized ratio

KW - ISS

KW - odds ratio

KW - OR

KW - prothrombin time

KW - PT

KW - SICU

KW - surgical ICU

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