Predictors of hypofibrinogenemia in blunt trauma patients on admission
Purpose Massive bleeding usually leads to critically low levels of clotting factors, including fibrinogen. Although reduced fibrinogen levels correlate with increased mortality, predictors of hypofibrinogenemia have remained poorly understood. We investigated whether findings available on admission...
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| Veröffentlicht in: | Journal of anesthesia 2015-04, Vol.29 (2), p.242-248 |
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| creator | Kimura, Yoshinobu Kimura, Saori Sumita, Shinzou Yamakage, Michiaki |
| description | Purpose
Massive bleeding usually leads to critically low levels of clotting factors, including fibrinogen. Although reduced fibrinogen levels correlate with increased mortality, predictors of hypofibrinogenemia have remained poorly understood. We investigated whether findings available on admission can be used as predictors of hypofibrinogenemia.
Methods
We retrospectively reviewed serum fibrinogen levels tested on arrival in 290 blunt trauma patients transported to a level I trauma center during a 3-year period. The primary outcome was prehospital predictors for hypofibrinogenemia. Covariates included age, sex, prehospital fluid therapy, prehospital anatomical and physiological scores, time from injury, base excess, and lactate on arrival. All variables with values of
p
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| doi_str_mv | 10.1007/s00540-014-1895-6 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1672606351</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A432511278</galeid><sourcerecordid>A432511278</sourcerecordid><originalsourceid>FETCH-LOGICAL-c543t-a3ab8addbe7b0ce19660d346d285d2dd5ea72d8f51a85488f9f2769abfd75bc03</originalsourceid><addsrcrecordid>eNp9kcFrHCEYxaU0NJu0f0AuZaCXXNz46eg4xyVkk0KgPbRncUbdGmZ0qzOH_e_jZtJAYCkeBP29j--9h9AVkDUQ0txkQnhNMIEag2w5Fh_QCmomsWS8_YhWpAWGpRDyHF3k_EQIEQDsEzqnHIBKoCu0_Zms8f0UU66iq_4c9tH5LvkQdzbY0evKh6ob5jBVU9LzqKu9nrwNU8FDpc3oc_YxfEZnTg_Zfnm9L9Hv7d2v2wf8-OP---3mEfe8ZhPWTHdSG9PZpiO9hVYIYlgtDJXcUGO41Q010nHQktdSutbRRrS6c6bhXU_YJbpe5u5T_DvbPKmyQG-HQQcb56xANFQQwTgU9NuC7vRglQ8uFgP9EVebmr0k0MhC4RPU0XvSQwzW-fL8jl-f4MsxJaz-pAAWQZ9izsk6tU9-1OmggKhji2ppUZUW1bFFJYrm66vLuRuteVP8q60AdAFy-Qo7m9RTnFMoyf9n6jPAC6Z5</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1672606351</pqid></control><display><type>article</type><title>Predictors of hypofibrinogenemia in blunt trauma patients on admission</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Kimura, Yoshinobu ; Kimura, Saori ; Sumita, Shinzou ; Yamakage, Michiaki</creator><creatorcontrib>Kimura, Yoshinobu ; Kimura, Saori ; Sumita, Shinzou ; Yamakage, Michiaki</creatorcontrib><description>Purpose
Massive bleeding usually leads to critically low levels of clotting factors, including fibrinogen. Although reduced fibrinogen levels correlate with increased mortality, predictors of hypofibrinogenemia have remained poorly understood. We investigated whether findings available on admission can be used as predictors of hypofibrinogenemia.
Methods
We retrospectively reviewed serum fibrinogen levels tested on arrival in 290 blunt trauma patients transported to a level I trauma center during a 3-year period. The primary outcome was prehospital predictors for hypofibrinogenemia. Covariates included age, sex, prehospital fluid therapy, prehospital anatomical and physiological scores, time from injury, base excess, and lactate on arrival. All variables with values of
p
< 0.10 in univariate analysis were included in a multivariate logistic regression model. The relationships between the variables and the 7-day mortality rate were evaluated in a Cox proportional hazards model.
Results
Patient’s age [odds ratio (OR): 0.97,
p
< 0.001], Triage Revised Trauma Score (T-RTS) (OR: 0.81,
p
= 0.003), and prehospital fluid therapy (OR: 2.54,
p
= 0.01) were detected as independent predictors for hypofibrinogenemia in multivariate logistic regression analysis. Serum fibrinogen level [hazard ratio (HR): 0.99,
p
= 0.01] and T-RTS (HR: 0.77,
p
< 0.01) were associated with the 7-day mortality rate.
Conclusion
T-RTS is considered to play an important role in predicting hypofibrinogenemia and 7-day mortality in blunt trauma patients.</description><identifier>ISSN: 0913-8668</identifier><identifier>EISSN: 1438-8359</identifier><identifier>DOI: 10.1007/s00540-014-1895-6</identifier><identifier>PMID: 25112812</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Adult ; Afibrinogenemia - diagnosis ; Afibrinogenemia - etiology ; Afibrinogenemia - mortality ; Age Factors ; Aged ; Analysis ; Anesthesiology ; Blunt trauma ; Care and treatment ; Critical Care Medicine ; Development and progression ; Emergency medical services ; Emergency Medicine ; Female ; Fibrinogen - analysis ; Fibrinogen - metabolism ; Glasgow Coma Scale ; Hemorrhage - complications ; Humans ; Intensive ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Pain Medicine ; Patient outcomes ; Predictive Value of Tests ; Registries ; Retrospective Studies ; Risk factors ; Trauma Severity Indices ; Treatment Outcome ; Triage ; Wounds, Nonpenetrating - blood ; Wounds, Nonpenetrating - complications ; Wounds, Nonpenetrating - mortality</subject><ispartof>Journal of anesthesia, 2015-04, Vol.29 (2), p.242-248</ispartof><rights>Japanese Society of Anesthesiologists 2014</rights><rights>COPYRIGHT 2015 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c543t-a3ab8addbe7b0ce19660d346d285d2dd5ea72d8f51a85488f9f2769abfd75bc03</citedby><cites>FETCH-LOGICAL-c543t-a3ab8addbe7b0ce19660d346d285d2dd5ea72d8f51a85488f9f2769abfd75bc03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00540-014-1895-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00540-014-1895-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25112812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kimura, Yoshinobu</creatorcontrib><creatorcontrib>Kimura, Saori</creatorcontrib><creatorcontrib>Sumita, Shinzou</creatorcontrib><creatorcontrib>Yamakage, Michiaki</creatorcontrib><title>Predictors of hypofibrinogenemia in blunt trauma patients on admission</title><title>Journal of anesthesia</title><addtitle>J Anesth</addtitle><addtitle>J Anesth</addtitle><description>Purpose
Massive bleeding usually leads to critically low levels of clotting factors, including fibrinogen. Although reduced fibrinogen levels correlate with increased mortality, predictors of hypofibrinogenemia have remained poorly understood. We investigated whether findings available on admission can be used as predictors of hypofibrinogenemia.
Methods
We retrospectively reviewed serum fibrinogen levels tested on arrival in 290 blunt trauma patients transported to a level I trauma center during a 3-year period. The primary outcome was prehospital predictors for hypofibrinogenemia. Covariates included age, sex, prehospital fluid therapy, prehospital anatomical and physiological scores, time from injury, base excess, and lactate on arrival. All variables with values of
p
< 0.10 in univariate analysis were included in a multivariate logistic regression model. The relationships between the variables and the 7-day mortality rate were evaluated in a Cox proportional hazards model.
Results
Patient’s age [odds ratio (OR): 0.97,
p
< 0.001], Triage Revised Trauma Score (T-RTS) (OR: 0.81,
p
= 0.003), and prehospital fluid therapy (OR: 2.54,
p
= 0.01) were detected as independent predictors for hypofibrinogenemia in multivariate logistic regression analysis. Serum fibrinogen level [hazard ratio (HR): 0.99,
p
= 0.01] and T-RTS (HR: 0.77,
p
< 0.01) were associated with the 7-day mortality rate.
Conclusion
T-RTS is considered to play an important role in predicting hypofibrinogenemia and 7-day mortality in blunt trauma patients.</description><subject>Adult</subject><subject>Afibrinogenemia - diagnosis</subject><subject>Afibrinogenemia - etiology</subject><subject>Afibrinogenemia - mortality</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Analysis</subject><subject>Anesthesiology</subject><subject>Blunt trauma</subject><subject>Care and treatment</subject><subject>Critical Care Medicine</subject><subject>Development and progression</subject><subject>Emergency medical services</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Fibrinogen - analysis</subject><subject>Fibrinogen - metabolism</subject><subject>Glasgow Coma Scale</subject><subject>Hemorrhage - complications</subject><subject>Humans</subject><subject>Intensive</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Pain Medicine</subject><subject>Patient outcomes</subject><subject>Predictive Value of Tests</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Trauma Severity Indices</subject><subject>Treatment Outcome</subject><subject>Triage</subject><subject>Wounds, Nonpenetrating - blood</subject><subject>Wounds, Nonpenetrating - complications</subject><subject>Wounds, Nonpenetrating - mortality</subject><issn>0913-8668</issn><issn>1438-8359</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFrHCEYxaU0NJu0f0AuZaCXXNz46eg4xyVkk0KgPbRncUbdGmZ0qzOH_e_jZtJAYCkeBP29j--9h9AVkDUQ0txkQnhNMIEag2w5Fh_QCmomsWS8_YhWpAWGpRDyHF3k_EQIEQDsEzqnHIBKoCu0_Zms8f0UU66iq_4c9tH5LvkQdzbY0evKh6ob5jBVU9LzqKu9nrwNU8FDpc3oc_YxfEZnTg_Zfnm9L9Hv7d2v2wf8-OP---3mEfe8ZhPWTHdSG9PZpiO9hVYIYlgtDJXcUGO41Q010nHQktdSutbRRrS6c6bhXU_YJbpe5u5T_DvbPKmyQG-HQQcb56xANFQQwTgU9NuC7vRglQ8uFgP9EVebmr0k0MhC4RPU0XvSQwzW-fL8jl-f4MsxJaz-pAAWQZ9izsk6tU9-1OmggKhji2ppUZUW1bFFJYrm66vLuRuteVP8q60AdAFy-Qo7m9RTnFMoyf9n6jPAC6Z5</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Kimura, Yoshinobu</creator><creator>Kimura, Saori</creator><creator>Sumita, Shinzou</creator><creator>Yamakage, Michiaki</creator><general>Springer Japan</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Predictors of hypofibrinogenemia in blunt trauma patients on admission</title><author>Kimura, Yoshinobu ; Kimura, Saori ; Sumita, Shinzou ; Yamakage, Michiaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c543t-a3ab8addbe7b0ce19660d346d285d2dd5ea72d8f51a85488f9f2769abfd75bc03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Afibrinogenemia - diagnosis</topic><topic>Afibrinogenemia - etiology</topic><topic>Afibrinogenemia - mortality</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Analysis</topic><topic>Anesthesiology</topic><topic>Blunt trauma</topic><topic>Care and treatment</topic><topic>Critical Care Medicine</topic><topic>Development and progression</topic><topic>Emergency medical services</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Fibrinogen - analysis</topic><topic>Fibrinogen - metabolism</topic><topic>Glasgow Coma Scale</topic><topic>Hemorrhage - complications</topic><topic>Humans</topic><topic>Intensive</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Pain Medicine</topic><topic>Patient outcomes</topic><topic>Predictive Value of Tests</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Trauma Severity Indices</topic><topic>Treatment Outcome</topic><topic>Triage</topic><topic>Wounds, Nonpenetrating - blood</topic><topic>Wounds, Nonpenetrating - complications</topic><topic>Wounds, Nonpenetrating - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kimura, Yoshinobu</creatorcontrib><creatorcontrib>Kimura, Saori</creatorcontrib><creatorcontrib>Sumita, Shinzou</creatorcontrib><creatorcontrib>Yamakage, Michiaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kimura, Yoshinobu</au><au>Kimura, Saori</au><au>Sumita, Shinzou</au><au>Yamakage, Michiaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of hypofibrinogenemia in blunt trauma patients on admission</atitle><jtitle>Journal of anesthesia</jtitle><stitle>J Anesth</stitle><addtitle>J Anesth</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>29</volume><issue>2</issue><spage>242</spage><epage>248</epage><pages>242-248</pages><issn>0913-8668</issn><eissn>1438-8359</eissn><abstract>Purpose
Massive bleeding usually leads to critically low levels of clotting factors, including fibrinogen. Although reduced fibrinogen levels correlate with increased mortality, predictors of hypofibrinogenemia have remained poorly understood. We investigated whether findings available on admission can be used as predictors of hypofibrinogenemia.
Methods
We retrospectively reviewed serum fibrinogen levels tested on arrival in 290 blunt trauma patients transported to a level I trauma center during a 3-year period. The primary outcome was prehospital predictors for hypofibrinogenemia. Covariates included age, sex, prehospital fluid therapy, prehospital anatomical and physiological scores, time from injury, base excess, and lactate on arrival. All variables with values of
p
< 0.10 in univariate analysis were included in a multivariate logistic regression model. The relationships between the variables and the 7-day mortality rate were evaluated in a Cox proportional hazards model.
Results
Patient’s age [odds ratio (OR): 0.97,
p
< 0.001], Triage Revised Trauma Score (T-RTS) (OR: 0.81,
p
= 0.003), and prehospital fluid therapy (OR: 2.54,
p
= 0.01) were detected as independent predictors for hypofibrinogenemia in multivariate logistic regression analysis. Serum fibrinogen level [hazard ratio (HR): 0.99,
p
= 0.01] and T-RTS (HR: 0.77,
p
< 0.01) were associated with the 7-day mortality rate.
Conclusion
T-RTS is considered to play an important role in predicting hypofibrinogenemia and 7-day mortality in blunt trauma patients.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>25112812</pmid><doi>10.1007/s00540-014-1895-6</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Afibrinogenemia - diagnosis Afibrinogenemia - etiology Afibrinogenemia - mortality Age Factors Aged Analysis Anesthesiology Blunt trauma Care and treatment Critical Care Medicine Development and progression Emergency medical services Emergency Medicine Female Fibrinogen - analysis Fibrinogen - metabolism Glasgow Coma Scale Hemorrhage - complications Humans Intensive Male Medicine Medicine & Public Health Middle Aged Original Article Pain Medicine Patient outcomes Predictive Value of Tests Registries Retrospective Studies Risk factors Trauma Severity Indices Treatment Outcome Triage Wounds, Nonpenetrating - blood Wounds, Nonpenetrating - complications Wounds, Nonpenetrating - mortality |
| title | Predictors of hypofibrinogenemia in blunt trauma patients on admission |
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