Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma

Analyses of a retrospective multicentre observational study

Yoshihiko Nakamura, Hiroyasu Ishikura, Shigeki Kushimoto, Fumiaki Kiyomi, Hiroshi Kato, Junichi Sasaki, Hiroshi Ogura, Tetsuya Matsuoka, Toshifumi Uejima, Naoto Morimura, Mineji Hayakawa, Akiyoshi Hagiwara, Munekazu Takeda, Naoyuki Kaneko, Daizoh Saitoh, Daisuke Kudo, Kunihiko Maekawa, Takashi Kanemura, Takayuki Shibusawa, Yasushi Hagihara & 8 others Shintaro Furugori, Atsushi Shiraishi, Kiyoshi Murata, Gou Mayama, Arino Yaguchi, Shiei Kim, Osamu Takasu, Kazutaka Nishiyama

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma. Methods We conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24 h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable. Results Higher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10 mm Hg), GCS, and Fbg levels (per 10 mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95% confidence interval [CI] 1.326–1.668; OR 0.851, 95% CI 0.789–0.914; OR 0.907, 95% CI 0.855–0.962; and OR 0.931, 95% CI 0.898–0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4%, specificity 79.8%), ≤120 mm Hg (sensitivity 61.5%, specificity 70.5%), ≤12 points (sensitivity 63.3%, specificity 63.6%), and ≤190 mg/dL (sensitivity 55.1%, specificity 78.6%), respectively. Conclusions Our findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT.

Original languageEnglish
Pages (from-to)674-679
Number of pages6
JournalInjury
Volume48
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

Fingerprint

Fibrinogen
Multicenter Studies
Observational Studies
Glasgow Coma Scale
Wounds and Injuries
Odds Ratio
Confidence Intervals
Sensitivity and Specificity
Vital Signs
Logistic Models
Blood Pressure
Erythrocyte Transfusion
Emergency Medical Services
Tertiary Healthcare
Critical Care
ROC Curve
Japan
Heart Rate
Regression Analysis
Hemorrhage

Keywords

  • Cut-off value
  • Fibrinogen
  • Glasgow coma scale
  • Heart rate
  • Massive transfusion
  • Sensitivity
  • Specificity
  • Systolic blood pressure
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma : Analyses of a retrospective multicentre observational study. / Nakamura, Yoshihiko; Ishikura, Hiroyasu; Kushimoto, Shigeki; Kiyomi, Fumiaki; Kato, Hiroshi; Sasaki, Junichi; Ogura, Hiroshi; Matsuoka, Tetsuya; Uejima, Toshifumi; Morimura, Naoto; Hayakawa, Mineji; Hagiwara, Akiyoshi; Takeda, Munekazu; Kaneko, Naoyuki; Saitoh, Daizoh; Kudo, Daisuke; Maekawa, Kunihiko; Kanemura, Takashi; Shibusawa, Takayuki; Hagihara, Yasushi; Furugori, Shintaro; Shiraishi, Atsushi; Murata, Kiyoshi; Mayama, Gou; Yaguchi, Arino; Kim, Shiei; Takasu, Osamu; Nishiyama, Kazutaka.

In: Injury, Vol. 48, No. 3, 01.03.2017, p. 674-679.

Research output: Contribution to journalArticle

Nakamura, Y, Ishikura, H, Kushimoto, S, Kiyomi, F, Kato, H, Sasaki, J, Ogura, H, Matsuoka, T, Uejima, T, Morimura, N, Hayakawa, M, Hagiwara, A, Takeda, M, Kaneko, N, Saitoh, D, Kudo, D, Maekawa, K, Kanemura, T, Shibusawa, T, Hagihara, Y, Furugori, S, Shiraishi, A, Murata, K, Mayama, G, Yaguchi, A, Kim, S, Takasu, O & Nishiyama, K 2017, 'Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma: Analyses of a retrospective multicentre observational study', Injury, vol. 48, no. 3, pp. 674-679. https://doi.org/10.1016/j.injury.2017.01.031
Nakamura, Yoshihiko ; Ishikura, Hiroyasu ; Kushimoto, Shigeki ; Kiyomi, Fumiaki ; Kato, Hiroshi ; Sasaki, Junichi ; Ogura, Hiroshi ; Matsuoka, Tetsuya ; Uejima, Toshifumi ; Morimura, Naoto ; Hayakawa, Mineji ; Hagiwara, Akiyoshi ; Takeda, Munekazu ; Kaneko, Naoyuki ; Saitoh, Daizoh ; Kudo, Daisuke ; Maekawa, Kunihiko ; Kanemura, Takashi ; Shibusawa, Takayuki ; Hagihara, Yasushi ; Furugori, Shintaro ; Shiraishi, Atsushi ; Murata, Kiyoshi ; Mayama, Gou ; Yaguchi, Arino ; Kim, Shiei ; Takasu, Osamu ; Nishiyama, Kazutaka. / Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma : Analyses of a retrospective multicentre observational study. In: Injury. 2017 ; Vol. 48, No. 3. pp. 674-679.
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title = "Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma: Analyses of a retrospective multicentre observational study",
abstract = "Introduction In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma. Methods We conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24 h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable. Results Higher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10 mm Hg), GCS, and Fbg levels (per 10 mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95{\%} confidence interval [CI] 1.326–1.668; OR 0.851, 95{\%} CI 0.789–0.914; OR 0.907, 95{\%} CI 0.855–0.962; and OR 0.931, 95{\%} CI 0.898–0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4{\%}, specificity 79.8{\%}), ≤120 mm Hg (sensitivity 61.5{\%}, specificity 70.5{\%}), ≤12 points (sensitivity 63.3{\%}, specificity 63.6{\%}), and ≤190 mg/dL (sensitivity 55.1{\%}, specificity 78.6{\%}), respectively. Conclusions Our findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT.",
keywords = "Cut-off value, Fibrinogen, Glasgow coma scale, Heart rate, Massive transfusion, Sensitivity, Specificity, Systolic blood pressure, Trauma",
author = "Yoshihiko Nakamura and Hiroyasu Ishikura and Shigeki Kushimoto and Fumiaki Kiyomi and Hiroshi Kato and Junichi Sasaki and Hiroshi Ogura and Tetsuya Matsuoka and Toshifumi Uejima and Naoto Morimura and Mineji Hayakawa and Akiyoshi Hagiwara and Munekazu Takeda and Naoyuki Kaneko and Daizoh Saitoh and Daisuke Kudo and Kunihiko Maekawa and Takashi Kanemura and Takayuki Shibusawa and Yasushi Hagihara and Shintaro Furugori and Atsushi Shiraishi and Kiyoshi Murata and Gou Mayama and Arino Yaguchi and Shiei Kim and Osamu Takasu and Kazutaka Nishiyama",
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TY - JOUR

T1 - Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma

T2 - Analyses of a retrospective multicentre observational study

AU - Nakamura, Yoshihiko

AU - Ishikura, Hiroyasu

AU - Kushimoto, Shigeki

AU - Kiyomi, Fumiaki

AU - Kato, Hiroshi

AU - Sasaki, Junichi

AU - Ogura, Hiroshi

AU - Matsuoka, Tetsuya

AU - Uejima, Toshifumi

AU - Morimura, Naoto

AU - Hayakawa, Mineji

AU - Hagiwara, Akiyoshi

AU - Takeda, Munekazu

AU - Kaneko, Naoyuki

AU - Saitoh, Daizoh

AU - Kudo, Daisuke

AU - Maekawa, Kunihiko

AU - Kanemura, Takashi

AU - Shibusawa, Takayuki

AU - Hagihara, Yasushi

AU - Furugori, Shintaro

AU - Shiraishi, Atsushi

AU - Murata, Kiyoshi

AU - Mayama, Gou

AU - Yaguchi, Arino

AU - Kim, Shiei

AU - Takasu, Osamu

AU - Nishiyama, Kazutaka

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Introduction In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma. Methods We conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24 h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable. Results Higher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10 mm Hg), GCS, and Fbg levels (per 10 mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95% confidence interval [CI] 1.326–1.668; OR 0.851, 95% CI 0.789–0.914; OR 0.907, 95% CI 0.855–0.962; and OR 0.931, 95% CI 0.898–0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4%, specificity 79.8%), ≤120 mm Hg (sensitivity 61.5%, specificity 70.5%), ≤12 points (sensitivity 63.3%, specificity 63.6%), and ≤190 mg/dL (sensitivity 55.1%, specificity 78.6%), respectively. Conclusions Our findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT.

AB - Introduction In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma. Methods We conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24 h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable. Results Higher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10 mm Hg), GCS, and Fbg levels (per 10 mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95% confidence interval [CI] 1.326–1.668; OR 0.851, 95% CI 0.789–0.914; OR 0.907, 95% CI 0.855–0.962; and OR 0.931, 95% CI 0.898–0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4%, specificity 79.8%), ≤120 mm Hg (sensitivity 61.5%, specificity 70.5%), ≤12 points (sensitivity 63.3%, specificity 63.6%), and ≤190 mg/dL (sensitivity 55.1%, specificity 78.6%), respectively. Conclusions Our findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT.

KW - Cut-off value

KW - Fibrinogen

KW - Glasgow coma scale

KW - Heart rate

KW - Massive transfusion

KW - Sensitivity

KW - Specificity

KW - Systolic blood pressure

KW - Trauma

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