Scripties UMCG - Rijksuniversiteit Groningen
 
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The course of fibrinogen levels over time and its association with early mortality in polytraumatized patients

(2017) Dahan, S. (Stephanie)

Background. Hemorrhage is the second most common cause of death in trauma patients and more than 50% of those deaths occur in the first 24 hours. Patients with severe blood loss tend to suffer from acute coagulation impairment named ‘trauma induced coagulopathy’ (TIC) and are unable to form clots and stop the body from hemorrhaging. The decrease in vital blood components leads to TIC in severe hemorrhages, and therefore, recognizing and dealing with massive blood loss is a crucial component in polytraumatized patients. Among other factors, it appears that low fibrinogen levels upon admission tend to be related to increased mortality risk. Ultimately, although it appears that fibrinogen has some connection with early mortality it is not yet fully known what is the definite role of fibrinogen in the process.
Objective. The main purpose of this study was to evaluate the association between the change in fibrinogen levels in polytraumatized patients in the first 24 from the moment they were admitted to the hospital and early mortality.
Materials and methods. This is a retrospective cohort study. 2537 adult patients (≥18 years of age) were admitted to the University Medical Center Groningen (UMCG) in the Netherlands due to polytrauma between the years 2004-2015. Our primary tested measurement was fibrinogen levels throughout the first 24 hours from admission, and generalized estimating equations were used to evaluate its association with early mortality. The study parameters included demographics, shock related parameters and coagulation related parameters.
Results. From a total of 2537 patient that were included in this research, only 7.81% (N=198) died in the first 24 hours of their admission. The surviving population showed a significantly different shock and coagulation related parameters. On average, the difference in fibrinogen levels over time between the surviving and non-surviving population is 1.18 g/L. The most significant change between the surviving and non-surviving population has occurred after the first 3 hours of admission. Demographics, shock related parameters and coagulation related parameters were controlled, and no relevant confounding variables were found.
Conclusion. A significant change over time in fibrinogen levels was found. In addition, there was a significant difference in change over time for fibrinogen between surviving and non-surviving trauma patients, even after adjusting for demographics, shock related and coagulation related parameters. Monitoring fibrinogen levels during the first 24 hours of injury may help getting a clearer image regarding the prognosis and assist in preventing early mortality.






 
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