Background: This prospective observational study aimed to evaluate the prognostic value of both measured and estimated plasma fibrinogen levels in predicting mortality and morbidity in critically ill trauma patients. Methods: A total of 80 severely injured trauma patients (Injury Severity Score [ISS] 3-5) were enrolled, along with 20 healthy controls for comparison. Fibrinogen levels were measured and estimated, and their correlation with clinical outcomes, including mortality, length of stay (LOS), and ICU duration, was analyzed.
Results:
A significant inverse correlation was observed between plasma fibrinogen levels and APACHE II scores (p = 0.0001).
Fibrinogen levels were significantly inversely correlated with ICU length of stay (p = 0.037).
A fibrinogen threshold of 5 mg/dl was found to predict survival with:
Sensitivity: 67%
Specificity: 78%
p-value: 0.007
A higher fibrinogen cutoff of 332 mg/dl was predictive of severe trauma (ISS 4 or 5), with an area under the curve (AUC) of 98, sensitivity of 100%, and specificity of 98%.
A lower cutoff value of 247 mg/dl demonstrated:
Sensitivity: 100%
Specificity: 75%
Base excess, hemoglobin, and Injury Severity Score (ISS) were incorporated into a statistical model for estimating log-transformed fibrinogen levels, yielding an R² of 79% and a correlation coefficient of 75% between estimated and measured log fibrinogen levels.
Lower fibrinogen levels were significantly associated with worse outcomes, including longer hospital stays. The estimation of fibrinogen levels in severe trauma cases is crucial for predicting survival and identifying patients who may benefit from targeted transfusion of coagulation factors. |
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