Fibrinogen degradation product levels on arrival for trauma patients requiring a transfusion even without head injury

doi:10.5847/wjem.j.1920-8642.2017.02.004

Abstract

Abstract:

BACKGROUND: There have been few reports on the clinical significance of the fibrinogen degradation product (FDP) level in trauma patients with and without head injury. We retrospectively analyzed trauma patients with or without head injury to investigate the clinical significance of the FDP level.

METHODS: From April 2013 to June 2015, a medical chart review was retrospectively performed for all patients with trauma. The exclusion criteria included patients who did not receive a transfusion. The patients were divided into two groups: a FDP>100 group, which included patients who had an FDP level on arrival over 100 ng/mL, and a FDP≤100 group.

RESULTS: The ratio of open fractures and the prothrombin ratio in the FDP>100 group were significantly smaller than those observed in the FDP≤100 group. The average age, ratio of blunt injury, Injury Severity Score (ISS), volume of transfusion and mortality ratio in the FDP>100 group were significantly greater than those in the FDP≤100 group. There was a weakly positive correlation between the FDP level and ISS (R=0.35, P=0.002), but it was not associated with the transfusion volume. The results of an analysis excluding patients with head injury showed a similar tendency.

CONCLUSION: The FDP levels may be a useful biochemical parameter for the initial evaluation of the severity of trauma and mortality even in blunt traumatized patients without head injury or with stable vital signs.

Key words: Fibrinogen degradation product, Injury Severity Score, Transfusion, Mortality

Youichi Yanagawa, Kouhei Ishikawa, Kei Jitsuiki, Toshihiko Yoshizawa, Yasumasa Oode, Kazuhiko Omori, Hiromichi Ohsaka. Fibrinogen degradation product levels on arrival for trauma patients requiring a transfusion even without head injury[J]. World Journal of Emergency Medicine, 2017, 8(2): 106-109.

Figures/Tables 3

Figure 1.

Table 1

Table 2

References 21

1	Suehiro E, Koizumi H, Fujiyama Y, Yoneda H, Suzuki M. Predictors of deterioration indicating a requirement for surgery in mild to moderate traumatic brain injury. Clin Neurol Neurosurg. 2014; 127:97-100. doi: 10.1016/j.clineuro.2014.10.007 pmid: 25459251
2	Selladurai BM, Vickneswaran M, Duraisamy S, Atan M. Coagulopathy in acute head injury—a study of its role as a prognostic indicator. Br J Neurosurg. 1997; 11(5):398-404. doi: 10.1080/02688699745880 pmid: 9474270
3	Saggar V, Mittal RS, Vyas MC. Hemostatic abnormalities in patients with closed head injuries and their role in predicting early mortality. J Neurotrauma. 2009; 26(10):1665-8. doi: 10.1089/neu.2008.0799 pmid: 19697972
4	Zhang LD, Liu HB, Li YN, Ma HM, Liu YB, Wang MY. Correlation analysis between plasma D-dimer levels and orthopedic trauma severity. Chin Med J (Engl). 2012; 125(17):3133-6.
5	Suehiro E, Koizumi H, Fujiyama Y, Yoneda H, Suzuki M. Predictors of deterioration indicating a requirement for surgery in mild to moderate traumatic brain injury. Clin Neurol Neurosurg. 2014; 127:97-100. doi: 10.1016/j.clineuro.2014.10.007 pmid: 25459251
6	Hagiwara S, Oshima K, Aoki M, Murata M, Ishihara K, Kaneko M, et al. Usefulness of fibrin degradation products and d-dimer levels as biomarkers that reflect the severity of trauma. J Trauma Acute Care Surg. 2013; 74(5):1275-8. doi: 10.1097/TA.0b013e31828cc967 pmid: 23609278
7	Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, et al. The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost. 2013; 11(2):307-14. doi: 10.1111/jth.12078
8	Turtay MG, Kirimliolu V, Ceylan C. Coagulopathy in multiple traumas. Ulus Travma Acil Cerrahi Derg. 2010; 16(3):198-202. pmid: 20517742
9	Carlin AM, Tyburski JG, Wilson RF, Steffes C. Factors affecting the outcome of patients with splenic trauma. Am Surg. 2002; 68(3):232-9. pmid: 11893100
10	Tornetta P 3rd, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, et al. Morbidity and mortality in elderly trauma patients. J Trauma. 1999; 46(4):702-6. pmid: 10217237
11	Mostafa G, Gunter OL, Norton HJ, McElhiney BM, Bailey DF, Jacobs DG. Age, blood transfusion, and survival after trauma. Am Surg. 2004; 70(4):357-63. pmid: 15098792
12	Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma. 2003; 54(5):898-905; discussion 905-7. doi: 10.1097/01.TA.0000060261.10597.5C pmid: 12777902
13	Robinson WP 3rd, Ahn J, Stiffler A, Rutherford EJ, Hurd H, Zarzaur BL, et al. Blood transfusion is an independent predictor of increased mortality in nonoperatively managed blunt hepatic and splenic injuries. J Trauma. 2005; 58(3):437-44; discussion 444-5. doi: 10.1097/01.ta.0000153935.18997.14 pmid: 15761334
14	Inoue K, Hifumi T, Kiriu N, Kanemura T, Okada I, Inoue J, et al. Acute coagulopathy after multiple blunt injuries in a case of hemophilia A-consideration for pathophysiology of coagulopathy. Am J Emerg Med. 2017; 35(1):194.e1-194.e3.
15	Johansson PI, Sørensen AM, Perner A, Welling KL, Wanscher M, Larsen CF, et al. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study. Crit Care. 2011; 15(6):R272. pmid: 22087841
16	Hayakawa M, Gando S, Ieko M, Honma Y, Homma T, Yanagida Y, et al. Massive amounts of tissue factor induce fibrinogenolysis without tissue hypoperfusion in rats. Shock. 2013; 39(6):514-9.
17	Cade J, Regoeczi E, Hirsh J, Buchanan M. The effect of experimental hematoma on serum levels of fibrinogen-related antigen. Blood. 1976; 47(5):855-9. pmid: 1260138
18	Omori K, Ishikawa K, Obinata M, Mishima K, Fukusato S, Ohsaka H, et al. Significance of the vacuum phenomenon in patients with trauma evaluated by whole-body computed tomography. Am J Emerg Med. 2015; 33(2):282-5. pmid: 25530190
19	Obinata M, Omori K, Ishikawa K, Osaka H, Oode Y, Yanagawa Y. Significance of pneumorrhachis detected by single-pass whole-body computed tomography in patients with trauma. J Emerg Trauma Shock. 2015; 8(2):120-1. doi: 10.4103/0974-2700.155524 pmid: 25949046
20	Soen S, Fujiwara S, Takayanagi R, Sato M, Tsujimoto M, Yamamoto T, et al. Japan Fracture Observational Study (JFOS): patient characteristics and interim data on the use of daily teriparatide in Japanese patients with osteoporosis. Curr Med Res Opin. 2015; 31(9):1771-9. doi: 10.1185/03007995.2015.1074063 pmid: 26189932
21	Arai H, Ouchi Y, Toba K, Endo T, Shimokado K, Tsubota K, et al. Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan. Geriatr Gerontol Int. 2015; 15(6):673-87. doi: 10.1111/ggi.12450 pmid: 25656311

Variables	FDP>100 (n=57)	FDP≤100 (n=44)	P value
Age (years)	66.8±2.7	58.3±3.0	<0.05
Sex (M/F)	30/27	31/13	0.10
Systolic blood pressure (mmHg)	103.5±5.5	118.2±6.9	n.s.
Heart rate (beats/minute)	83.4±3.5	85.3±3.9	n.s.
Glasgow Coma Scale	11.7±0.5	11.6±0.6	n.s.
Type of injury, n (%)			<0.01
Blunt	57 (100)	38 (86.4)
Penetrating	0	6 (13.6)
Mechanism of injury, n (%)
Traffic accident	44 (77.2)	25 (56.9)
Fall	13 (22.8)	9 (20.4)
Others	0	10 (22.7)
Injury Severity Score	19.7±1.4	13.3±1.7	<0.01
Open fracture, n (%)	6 (10.5)	12 (27.2)	<0.05
Ratio of cerebral lesions, n (%)	10 (17.5)	3 (6.8)	n.s.
Hemoglobin (g/dL)	10.9±0.2	11.1±0.3	n.s.
Creatinine phosphokinesis (IU/L)	561.5±65.0	645.2±208.9	n.s.
Prothrombin time (%)	78.2±3.4	89.0±3.7	<0.05
FDP (μg/mL)	330.3±52.7	37.2±4.2	<0.0001
Transfusion (U)	13.0±1.4	8.1±1.3	<0.05
Mortality rate, n (%)	12 (21.0)	2 (4.5)	<0.05

Variables	FDP>100 (n=47)	FDP≤100 (n=41)	P value
Age (years)	68.0±2.5	58.5±3.0	0.01
Sex (M/F)	26/21	30/11	0.08
Systolic blood pressure (mmHg)	105.7±5.7	119.3±7.2	n.s.
Heart rate (beats/minute)	86.7±3.5	84.9±4.0	n.s.
Glasgow Coma Scale	12.2±0.6	11.8±0.6	n.s.
Type of injury, n (%)			<0.01
Blunt	47 (100)	35 (85.4)
Penetrating	0	6 (14.6)
Mechanism of injury, n (%)
Traffic accident	38 (80.9)	22 (53.8)
Fall	9 (19.1)	9 (21.9)
Others	0	10 (24.3)
Injury Severity Score	19.3±1.7	13.0±1.8	0.01
Open fracture, n (%)	5 (10.6)	12 (29.2)	<0.05
Hemoglobin (g/dL)	11.4±0.3	11.3±0.3	n.s.
Creatinine phosphokinesis (IU/L)	579.3±69.9	675.0±224.1	n.s.
Prothrombin time (%)	78.2±3.6	91.0±3.1	0.01
FDP (μg/mL)	347.7±63.5	34.9±4.3	<0.0001
Transfusion (U)	13.6±1.7	7.5±1.1	<0.01
Mortality rate, n (%)	10 (21.2)	2 (4.8)	<0.05

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