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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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ID 3556
Moeder ID 3463
Volgorde Dahan, S.
Naam DahanS
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2017/DahanS/
Gemaakt op: 2017-08-22 09:34:29
Gemodificeerd op: 2017-08-22 09:34:29
Digitaal ID 599bfaa6c6dd9
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel The course of fibrinogen levels over time and its association with early mortality in polytraumatized patients
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 25
Publicatiejaar 2017
Taal en
Engelse samenvatting 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.
Nederlandse samenvatting Achtergrond. Hemorragie is de op één na meest voorkomende doodsoorzaak bij traumapatiënten en meer dan 50% van deze sterfgevallen gebeuren tijdens de eerste 24 uur. Patiënten met ernstig bloedverlies lijden vaak aan een acute stolling stoornis genaamd 'trauma geïnduceerde coagulopathie' (TIC) en het lichaam is niet in staat om de bloeding te stollen of te stoppen. Bij ernstige bloedingen leidt de daling van de vitale bloedcomponenten tot TIC , en dus, het herkennen van en omgaan met massaal bloedverlies is een essentieel onderdeel in polytrauma patiënten. Bij opname blijkt onder meer dat lage fibrinogeen gehaltes samenhangen met een verhoogd sterfterisico. Alhoewel er een samenhang blijkt te zijn tussen een lage fibrinogeen gehalte en vroege mortaliteit, is het nog niet volledig bekend wat de definitieve rol van fibrinogeen is in het proces.
Doelstelling. Het belangrijkste doel van deze onderzoek was het evalueren van de associatie tussen de verandering van het fibrinogeen gehalte bij polytrauma patiënten, in de eerste 24 uur vanaf het moment dat ze in het ziekenhuis opgenomen worden en het vroegtijdig sterven.
Materialen en methode. Dit is een retrospectieve cohortonderzoek. 2537 volwassen patiënten (≥18 jaar oud) werden opgenomen in het Universitair Medisch Centrum Groningen (UMCG) in Nederland als gevolg van polytrauma tussen de jaren 2004-2015. Onze primaire meting dat getest werd was fibrinogeen gehaltes gedurende de eerste 24 uur van opname en gegeneraliseerde schattingsvergelijkingen werden gebruikt om de associatie bij vroege mortaliteit te evalueren. De studie parameters zijn demografie, shock parameters en coagulatie parameters.
Resultaten. Van een totaal van 2537 patiënten die waren opgenomen in dit onderzoek, stierven slechts 7,81% (N = 198) in de eerste 24 uur na hun opname. De overlevende populatie toonde een significant verschil in shock en coagulatie parameters. Gemiddeld, is het verschil in fibrinogeen gehaltes in het verloop van tijd tussen de overlevende en niet overlevende populatie 1,18 g/L. De meest significante verandering tussen de overlevende en niet overlevende populatie is opgetreden na de eerste 3 uur van opname. Demografie, shock parameters en bloedstolling gerelateerde parameters werden gecontroleerd, en geen relevante confounding variabelen werden gevonden.
Conclusie. In de loop van tijd werd een significante verandering in fibrinogeen gehaltes gevonden. Bovendien was er een significant verschil in de loop van tijd van fibrinogeen tussen overlevende en niet overlevende trauma patiënten, zelfs na het aanpassen van de demografie, shock en coagulatie parameters. Het monitoren van fibrinogeen gehaltes gedurende de eerste 24 uur na letsel kan helpen om een betere beeld van de prognose te krijgen en het kan helpen bij het voorkomen van vroege mortaliteit.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Dahan, S. (Stephanie)
UMCG begeleider(s) Supervisor: M. el Moumni, MD, trauma surgeon; Department: Department of trauma surgery; Institution: University Medical Center Groningen
Auteur(s) Dahan, S. (Stephanie)
UMCG begeleider(s) Supervisor: M. el Moumni, MD, trauma surgeon; Department: Department of trauma surgery; Institution: University Medical Center Groningen


 
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