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

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 signifi cance 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 signifi cantly 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.

A High Level of Fibrinogen Degradation Product on Arrival as the Only Clue Suggesting Deterioration in a Blunt Trauma Patient

“…However, the patient showed a markedly increased level of FDP, a biomarker used to predict the outcome in trauma patients [4][5][6]. Even when vital signs are stable and trauma is not very severe, a high FDP level on arrival may predict the need for transfusion or a poor outcome [4][5][6]. An FDP value exceeding 150 μg/ml on arrival suggests a potentially fatal outcome, so careful observation should be undertaken for such patients [6].…”

The fibrin/fibrinogen degradation product level on arrival in trauma patients is a better predictor of a fatal outcome than physiological or anatomical severity: A retrospective chart review

“…[14][15][16][17] Regarding the mechanism underlying the positive correlation between the FDP level and the severity of trauma, an increase in the release of tissue factor, which causes fibrinolysis or the formation of a hematoma, depending on the severity of the trauma, might be involved. 3 The increase in the FDP level on arrival reflects coagulation abnormality after injury, 14 and it has been suggested that the increase in FDP is correlated with the amount of blood transfusion. 3,18 Fibrinogen is essential for clot formation and platelet aggregation; during major blood loss, fibrinogen decreases due to fibrinolysis to critically low levels earlier than the other coagulation factors.…”

“…3 The increase in the FDP level on arrival reflects coagulation abnormality after injury, 14 and it has been suggested that the increase in FDP is correlated with the amount of blood transfusion. 3,18 Fibrinogen is essential for clot formation and platelet aggregation; during major blood loss, fibrinogen decreases due to fibrinolysis to critically low levels earlier than the other coagulation factors. 2 Fibrinogen reduction due to fibrinolysis results in an increase in the FDP level and coagulopathy.…”

“…1 As well as in head injury patients, FDP levels on arrival have also been reported to be useful biochemical markers for assessing the severity of trauma in patients with trauma at other sites. [2][3][4] However, physiological signs (vital signs) and the severity of traumatic anatomical abnormality have traditionally been used as markers for predicting the outcomes of trauma patients. [5][6][7] Few reports have investigated which factors among vital signs, the severity of traumatic anatomical abnormality and biochemical data are most useful for predicting the outcomes of trauma patients.…”

Clinical Application of Coagulation Biomarkers

“…In addition, in this study we calculated the ratios of FDP to fibrinogen, and of D-dimer to fibrinogen. Fibrinogen is said to be an independent risk factor of mortality and severity in blunt trauma patients [38][39][40], and a predictor of transfusion [41,42]. We combined the high FDP and D-dimer, and the low fibrinogen, to the ratio of FDP to fibrinogen and the ratio of D-dimer to fibrinogen, this was a novel finding.…”