Fibrinogen level on admission is a predictive marker of the need for massive blood transfusion after pelvic fracture - 08/06/20

Doi : 10.1016/j.ajem.2019.06.043

Naoki Notani, MD, PhD ^a, Masashi Miyazaki, MD, PhD ^a,^{^⁎} , Shozo Kanezaki, MD ^a, Toshinobu Ishihara, MD, PhD ^a, Tomonori Sakamoto, MD ^a, Testsutaro Abe, MD ^a, Masashi Kataoka, MD, PhD ^b, Hiroshi Tsumura, MD, PhD ^a
^a Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
^b Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan

^⁎Corresponding author at: Department of Orthopedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan.Department of Orthopedic SurgeryFaculty of MedicineOita University1-1 Idaigaoka, Hasama-machiYufu-shiOita879-5593Japan

Abstract

Objective

This study aimed to evaluate the usefulness of coagulation biomarkers as predictors of the need for massive transfusion (MT) in patients with pelvic fractures.

Methods

Patients who were treated for pelvic fractures in our hospital were divided into 2 groups: MT and non-MT. MT was defined as the transfusion of packed red blood cells (PRBCs) ≧10 units caused by bleeding within 24 h after admission. We compared variables between two groups, including vital signs, the scoring system and blood sample test. Additionally, we performed a multiple logistic regression analysis and a receiver operating characteristic curve analysis to reveal which value was the most useful predictive marker for MT in patients with pelvic fracture.

Results

There were 22 patients in the MT group and 78 patients in the non-MT group. Patients in the MT group had significantly higher ISS than did those in the non-MT group. In contrast, the patients in the MT group had significantly lower RTS, TRISS Ps, sBP, Hb, lactate, BE, and Fbg levels. Lower sBP and Fbg levels were independent predictors for MT. The optimal cut-off values for sBP and Fbg levels were ≦109 mmHg and 193.0 mg/dL, respectively.

Conclusions

The results of the study indicated that Fbg levels on admission can be an independent predictor of MT in patients with pelvic fractures. The optimal cut-off value of Fbg for MT prediction in this study was 193.0 mg/dL.

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Keywords : Pelvic fracture, Massive transfusion, Fibrinogen