High fibrin/fibrinogen degradation product to fibrinogen ratio is associated with 28-day mortality and massive transfusion in severe trauma
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There is a lack of association between coagulation biomarkers and long-term mortality in severe trauma. We aimed to investigate the association between coagulation biomarkers on admission and outcome of late stage of trauma.
This retrospective observational study included patients admitted with severe trauma between 2012 and 2015. We used the area under the receiver operating characteristic curve (AUROC) of coagulation biomarkers to determine 28-day mortality. Head Abbreviated Injury Scale scores greater than 3 were defined as traumatic brain injury (TBI). The primary outcome was 28-day mortality and the secondary outcome was massive transfusion.
Of the 1266 patients included in the study, 28-day mortality rate was 19.7% (n = 249) and 7.9% (n = 100) of patients received massive transfusion. The AUROC of fibrin/fibrinogen degradation product (FDP) to fibrinogen ratio had a significantly higher prognostic performance than other markers. Multivariate analysis revealed that d-dimer level [odds ratio (OR) 1.033; 95% confidence interval (CI) 1.016–1.051] and FDP/fibrinogen ratio (OR 1.007; 95% CI 1.001–1.013) were independently associated with 28-day mortality. d-dimer (OR 1.028; 95% CI 1.003–1.055) and FDP/fibrinogen ratio (OR 1.035; 95% CI 1.012–1.058) were associated with 28-day mortality in the TBI group. In the non-TBI group, d-dimer was associated with 28-day mortality (OR 1.033; 95% CI 1.008–1.059), but the FDP/fibrinogen ratio was not. FDP/fibrinogen ratio, not d-dimer level, was an independent predictor for massive transfusion (OR 1.005; 95% CI 1.001–1.010).
High FDP/fibrinogen ratio on arrival is a predictor of 28-day mortality and the requirement for massive transfusion in severe trauma.
KeywordsTrauma Prognosis Massive transfusion Fibrinogen Fibrin/fibrinogen degradation products (FDP) d-dimer
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Conflict of interest
All authors (Dong Hun Lee, Byung Kook Lee, Sang Mi Noh, Yong Soo Cho) report no conflicts of interest relevant to this article. No funds were received by any of the authors in support of this study.
The present study protocol was reviewed and approved by the institutional review board of Chonnam National University College of Medicine (Reg. No. CNUH-2017-076).
Informed consent was waived due to the retrospective nature of the study by the institutional review board.