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Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?

BACKGROUND: In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L(−1), but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L(−1) or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was t...

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Autores principales: David, Jean-Stephane, Lambert, Aline, Taverna, Xavier-Jean, Incagnoli, Pascal, Geay-Baillat, Marie-Odile, Vassal, Olivia, Friggeri, Arnaud, Inaba, Kenji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8709958/
https://www.ncbi.nlm.nih.gov/pubmed/34952618
http://dx.doi.org/10.1186/s13049-021-00988-x
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author David, Jean-Stephane
Lambert, Aline
Taverna, Xavier-Jean
Incagnoli, Pascal
Geay-Baillat, Marie-Odile
Vassal, Olivia
Friggeri, Arnaud
Inaba, Kenji
author_facet David, Jean-Stephane
Lambert, Aline
Taverna, Xavier-Jean
Incagnoli, Pascal
Geay-Baillat, Marie-Odile
Vassal, Olivia
Friggeri, Arnaud
Inaba, Kenji
author_sort David, Jean-Stephane
collection PubMed
description BACKGROUND: In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L(−1), but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L(−1) or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h. METHODS: Prospective analysis of retrospectively collected data from a trauma registry (01/2011–12/2019). MFD-C was defined by a fibrinogenemia 1.51–1.99 g L(−1) or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L(−1) (HemoCue®), and base deficit > 5 mEq L(−1). Data are expressed as count (%), median [IQR]. RESULTS: 1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19–36] vs. 24 [17–29]) and had more impaired vital signs (base deficit: 5.4 [3.6–7.8] vs. 3.8 [2.0–6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L(−1) and < 2.0 g L(−1), FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L(−1), or a base deficit > 5.0 mEq L(−1) received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06–1.82] for MFD-C, and 2.17 [1.48–3.19] for MFD-A5. Results were not modified after adjustment on the ISS. CONCLUSIONS: We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD.
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spelling pubmed-87099582022-01-05 Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation? David, Jean-Stephane Lambert, Aline Taverna, Xavier-Jean Incagnoli, Pascal Geay-Baillat, Marie-Odile Vassal, Olivia Friggeri, Arnaud Inaba, Kenji Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L(−1), but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L(−1) or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h. METHODS: Prospective analysis of retrospectively collected data from a trauma registry (01/2011–12/2019). MFD-C was defined by a fibrinogenemia 1.51–1.99 g L(−1) or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L(−1) (HemoCue®), and base deficit > 5 mEq L(−1). Data are expressed as count (%), median [IQR]. RESULTS: 1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19–36] vs. 24 [17–29]) and had more impaired vital signs (base deficit: 5.4 [3.6–7.8] vs. 3.8 [2.0–6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L(−1) and < 2.0 g L(−1), FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L(−1), or a base deficit > 5.0 mEq L(−1) received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06–1.82] for MFD-C, and 2.17 [1.48–3.19] for MFD-A5. Results were not modified after adjustment on the ISS. CONCLUSIONS: We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD. BioMed Central 2021-12-24 /pmc/articles/PMC8709958/ /pubmed/34952618 http://dx.doi.org/10.1186/s13049-021-00988-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Research
David, Jean-Stephane
Lambert, Aline
Taverna, Xavier-Jean
Incagnoli, Pascal
Geay-Baillat, Marie-Odile
Vassal, Olivia
Friggeri, Arnaud
Inaba, Kenji
Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?
title Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?
title_full Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?
title_fullStr Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?
title_full_unstemmed Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?
title_short Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?
title_sort which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8709958/
https://www.ncbi.nlm.nih.gov/pubmed/34952618
http://dx.doi.org/10.1186/s13049-021-00988-x
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