Early Predictive Factors of Hypofibrinogenemia in Acute Trauma Patients

BACKGROUND: Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy. AIMS: The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients. SETTINGS AND DESIGN: This 2-year retrospective work examined the data of major trauma patients that were referred to Shahid Rajaee Hospital's emergency room in hemorrhagic shock condition. MATERIALS AND METHODS: Fibrinogen level was assessed for these patients on their arrival at our facility. Along with clinical and routine paraclinical variables, we evaluated the predictive value of these variables for a fibrinogen level below 100 mg/ml. RESULTS: A total of 855 cases were included (females: 16.4%; and males: 83.6%) in the study. The mean ± SD age was 36 ± 17.9 years, and the mean ± SD injury severity score was 12.2 ± 9. Motor vehicle accident was the most common cause of injury. Three factors, including arterial pH (cut off point = 7.34; area under the curve [AUC]: 0.59), base excess (cutoff point = −4.3; AUC: 0.60), and patients' gender had a significant association with the fibrinogen level under 100 mg/ml. When three factors of pH, BE, and patients' gender are being assessed simultaneously, the AUC became 0.62 (the predictive ability improved). CONCLUSIONS: Variables, including arterial pH, BE level, and patients' gender have predictive value for fibrinogen transfusion in trauma.