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) , Francois-Xavier Ageron (2) , Jonathan Charbit (3) , Xavier Bobbia , Pauline Deras , Jennifer Bas Dit Nugues , Etienne Escudier , Guillaume Marcotte , Marc Leone (4, 5) , Jean-Stephane David (6)

1 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
2 Hôpital d'Annecy
3 CHU Montpellier
4 MEPHI - Microbes évolution phylogénie et infections
5 APHM - Assistance Publique - Hôpitaux de Marseille
6 UCBL - Université Claude Bernard Lyon 1

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.

Mots clés: Fibrinogen; Mortality; Massive transfusion; Severe trauma

Domaines: Médecine humaine et pathologie

Pierre Bouzat, Francois-Xavier Ageron, Jonathan Charbit, Xavier Bobbia, Pauline Deras, et al.. 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. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2018, 26, pp.55. ⟨10.1186/s13049-018-0523-0⟩. ⟨hal-01858905⟩