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Early prediction for massive fresh frozen plasma transfusion based on fibrinogen/fibrin degradation products and D-dimer in patients with blunt trauma: a single-center, retrospective cohort study

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Abstract

Purpose

This study aimed to examine the association of fibrinogen/fibrin degradation product (FDP) values in comparison with D-dimer and fibrinogen (Fib) values and the need for massive fresh frozen plasma (FFP) transfusion in patients with blunt trauma.

Methods

This retrospective study included patients with blunt trauma aged ≥ 18 years who were transported directly to the tertiary care hospital between April, 2012, and March, 2021. Massive FFP transfusion was defined as a composite outcome of at least 10 units of FFP or death for any cause except for cerebral herniation, within 24 h after hospital arrival. We evaluated the diagnostic accuracy of predicting the need for massive FFP transfusions using FDP, D-dimer, and Fib levels at the time of hospital arrival.

Results

A total of 2160 patients were eligible for the analysis, of which 167 fulfilled the criteria for the composite outcome. The area under the curve and 95% confidence interval for FDP, D-dimer, and Fib levels were 0.886 (0.865–0.906), 0.885 (0.865–0.906), and 0.771 (0.731–0.810), respectively. When the cutoff values of FDP and D-dimer were set at 90 μg/mL and 45 μg/mL, the sensitivity values were 77% and 78%, the positive predictive values were 28% and 27%, and the negative predictive values were both 98%, respectively. In contrast, the sensitivity of Fib was low regardless of the cutoff value.

Conclusion

FDP and D-dimer levels at the time of hospital arrival showed a higher predictive accuracy for the need for massive FFP transfusion than Fib.

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Data availability

The raw data that support the findings of this study are available from Hyogo Emergency Medical Center, but the availability of these data is restricted.

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Acknowledgements

We would like to thank Hyogo Emergency Medical Center for their cooperation in collecting our research data and the members at Kyoto University School of Public Health for their constant and stimulating discussions. We also would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Preventing Services, School of Public Health, Kyoto University, Kyoto, Japan

    Masafumi Fukushima, Takeyuki Kiguchi, Norihiro Nishioka, Yukiko Tateyama, Tomonari Shimamoto & Taku Iwami

  2. Department of Emergency and Critical Care Medicine, Japan Red Cross Society Wakayama Medical Center, Wakayama, Japan

    Masafumi Fukushima

  3. Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan, 558-8558, 3-1-56 Bandaihigashi Sumiyoshi-Ku

    Takeyuki Kiguchi

  4. Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan

    Saki Ikegaki, Akihiko Inoue & Satoshi Ishihara

Authors
  1. Masafumi Fukushima
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  2. Takeyuki Kiguchi
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  9. Taku Iwami
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Masafumi fukushima and Saki Ikegaki. Material preparation and analysis were performed by Masafumi fukushima and Takeyuki Kiguchi. The first draft of the manuscript was written by Masafumi Fukushima, and all authors commented on previous versions of the manuscript. The entire study was supervised by Taku Iwami. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takeyuki Kiguchi.

Ethics declarations

Ethics approval

This study was approved by the Kyoto University Graduate School and Faculty of Medicine Ethics Committee and the Ethics Committee of the Hyogo Emergency Medical Center.

Consent to participate

The study used only medical information, and an opt-out approach provided all participants with the opportunity to withdraw consent.

Consent for publication

The study used only medical information, and an opt-out approach provided all participants with the opportunity to withdraw consent.

Competing interests

The authors declare no competing interests.

Supplementary information

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Fukushima, M., Kiguchi, T., Ikegaki, S. et al. Early prediction for massive fresh frozen plasma transfusion based on fibrinogen/fibrin degradation products and D-dimer in patients with blunt trauma: a single-center, retrospective cohort study. Eur J Trauma Emerg Surg 50, 603–610 (2024). https://doi.org/10.1007/s00068-024-02452-8

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  • DOI: https://doi.org/10.1007/s00068-024-02452-8

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