Impact of fibrinogen level on the prognosis of patients with traumatic brain injury: a single-center analysis of 2570 pa
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(2020) 15:54
RESEARCH ARTICLE
Open Access
Impact of fibrinogen level on the prognosis of patients with traumatic brain injury: a single-center analysis of 2570 patients Ke Lv†, Qiang Yuan†, Pengfei Fu, Gang Wu, Xing Wu, Zhuoying Du, Jian Yu, Zhiqi Li and Jin Hu*
Abstract Background: Fibrinogen may play an important role in the survival of trauma patients; however, its role in traumatic brain injury (TBI) and its correlation with disease prognosis remain poorly understood. The aims of this study were to determine the incidence of TBI-associated hypofibrinogenemia in patients with TBI and to evaluate the prognostic value of fibrinogen level with respect to mortality and clinical outcomes. Methods: A total of 2570 consecutive TBI patients were retrospectively studied. Prognostic evaluations were determined using the Glasgow Outcome Score (GOS) assessment 3 months after injury. The shape of the relationship between fibrinogen level and mortality or outcome was examined using cubic spline functions. Logistic regression analyses were conducted to identify the association between fibrinogen level and 3-month functional outcomes. Results: Fibrinogen concentrations < 2 g/L were observed in 992 (38.6%) patients at the time of admission. Multivariate analyses showed that for patients with fibrinogen levels < 2.0 g/L, those levels were an independent prognostic factor for 3-month mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.89–0.93; P < .001). By contrast, for patients with fibrinogen levels < 2.5 g/L, the levels were an independent prognostic factor for favorable outcomes at 3 months (OR, 1.654; 95% CI, 1.186–2.306; P = .003). Similar results were also seen for patients with fibrinogen levels > 3.0 g/L, with the levels being an independent prognostic factor for favorable outcomes at 3 months (OR, 0.771; 95% CI, 0.607–0.979; P = .033). Conclusions: Fibrinogen is an independent prognostic factor for clinical outcomes in TBI patients. Maintaining the level of fibrinogen between 2.5 and 3 g/L may improve clinical outcomes in patients with TBI. Keywords: Traumatic brain injury, Fibrinogen, Coagulopathy, Mortality, Outcomes
Background Traumatic brain injury (TBI) is a common factor contributing to neurological morbidity and the main cause of disability affecting patient function and quality of life [1]. Coagulopathies play an important role in the progression of intracranial hemorrhage and unfavorable * Correspondence: [email protected] † Ke Lv and Qiang Yuan contributed equally to this work. Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, China
outcomes after TBI [2]. Among the various factors affecting coagulation, fibrinogen is crucial for platelet aggregation, serving as the primary substrate for plasmatic coagulation, resulting in a mesh network used to enhance clot strength [3]. However, despite its importance, fibrinogen remains among the most vulnerable of the coagulation factors in patients sustaining serious injuries. In the early stages of trauma
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