Title |
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
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Published in |
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, July 2018
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DOI | 10.1186/s13049-018-0523-0 |
Pubmed ID | |
Authors |
Pierre Bouzat, François-Xavier Ageron, Jonathan Charbit, Xavier Bobbia, Pauline Deras, Jennifer Bas Dit Nugues, Etienne Escudier, Guillaume Marcotte, Marc Leone, Jean-Stéphane David |
Abstract |
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. 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. 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. 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. |
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Country | Count | As % |
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France | 1 | 17% |
Malaysia | 1 | 17% |
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Spain | 1 | 17% |
Unknown | 2 | 33% |
Demographic breakdown
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Members of the public | 4 | 67% |
Science communicators (journalists, bloggers, editors) | 1 | 17% |
Practitioners (doctors, other healthcare professionals) | 1 | 17% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 47 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Other | 9 | 19% |
Student > Ph. D. Student | 6 | 13% |
Student > Master | 6 | 13% |
Unspecified | 3 | 6% |
Student > Bachelor | 3 | 6% |
Other | 11 | 23% |
Unknown | 9 | 19% |
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Medicine and Dentistry | 27 | 57% |
Unspecified | 3 | 6% |
Biochemistry, Genetics and Molecular Biology | 1 | 2% |
Nursing and Health Professions | 1 | 2% |
Mathematics | 1 | 2% |
Other | 2 | 4% |
Unknown | 12 | 26% |