High D-dimer levels predict a poor outcome in patients with severe trauma, even with high fibrinogen levels on arrival

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

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Elevated D-dimer level in trauma patients is associated with tissue damage severity and is an indicator of hyperfibrinolysis during the early phase of trauma. To investigate the interacting effects of fibrinogen and D-dimer levels on arrival at the emergency department for massive transfusion and mortality in severe trauma patients in a multicenter retrospective study. This study included 519 adult trauma patients with an injury severity score ≥16. Patients with ≥10 units of red cell concentrate transfusion and/or death during the first 24h were classified as having a poor outcome. Receiver operating characteristic curve analysis for predicting poor outcome showed the optimal cut-off fibrinogen and D-dimer values to be 190mg/dL and 38mg/L, respectively. On the basis of these values, patients were divided into four groups: low D-dimer (<38mg/L)/high fibrinogen (>190mg/dL), low D-dimer (<38mg/L)/low fibrinogen (≤190mg/dL), high D-dimer (≥38mg/L)/high fibrinogen (>190mg/dL), and high D-dimer (≥38mg/L)/low fibrinogen (≤190mg/dL). The survival rate was lower in the high D-dimer/low fibrinogen group than in the other groups. Moreover, the survival rate was lower in the high D-dimer/high fibrinogen group than in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. High D-dimer level on arrival is a strong predictor of early death or requirement for massive transfusion in severe trauma patients, even with high fibrinogen levels.

Original languageEnglish
Pages (from-to)308-314
Number of pages7
JournalShock
Volume45
Issue number3
DOIs
Publication statusPublished - 2016 Mar 1

Keywords

  • Coagulopathy
  • disseminated intravascular coagulation
  • fibrin fibrinogen degradation products
  • fibrinolysis
  • multiple trauma
  • transfusion

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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