title: Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma: Analyses of a retrospective multicentre observational study.
abstract: BACKGROUND
  In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma.
  
  
  METHODS
  We conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable.
  
  
  RESULTS
  Higher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10mm Hg), GCS, and Fbg levels (per 10mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95% confidence interval [CI] 1.326-1.668; OR 0.851, 95% CI 0.789-0.914; OR 0.907, 95% CI 0.855-0.962; and OR 0.931, 95% CI 0.898-0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4%, specificity 79.8%), ≤120mm Hg (sensitivity 61.5%, specificity 70.5%), ≤12 points (sensitivity 63.3%, specificity 63.6%), and ≤190mg/dL (sensitivity 55.1%, specificity 78.6%), respectively.
  
  
  CONCLUSIONS
  Our findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT.
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. Electronic address: pdmxy827@yahoo.co.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. Electronic address: ishikurah@fukuoka-u.ac.jp.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikura
authors.affiliation: Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. Electronic address: kussie@emergency-medicine.med.tohoku.ac.jp.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kushimoto
authors.affiliation: Academia, Industry and Government Collaborative Research Institute of Translational Medicine for Life Innovation, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. Electronic address: fumkiyomi@adm.fukuoka-u.ac.jp.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kiyomi
authors.affiliation: Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan. Electronic address: hiromayu@mub.biglobe.ne.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Emergency & Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: sasakij@1989.jukuin.keio.ac.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Sasaki
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: ogura@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.affiliation: Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku Orai-kita Izumisano, Osaka 598-8577, Japan. Electronic address: t-matsuoka@rgmc.izumisano.osaka.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Matsuoka
authors.affiliation: Department of Emergency and Critical Care Medicine, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan. Electronic address: uejiman@gmail.com.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Uejima
authors.affiliation: Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho Minami-ku, Yokohama 232-0024, Japan. Electronic address: molimula@yokohama-cu.ac.jp.
authors.forename: Naoto
authors.initials: N
authors.lastname: Morimura
authors.affiliation: Emergency and Critical Care Center, Hokkaido University Hospital N14W5, Kita-ku, Sapporo 060-8648, Japan. Electronic address: mineji@dream.com.
authors.forename: Mineji
authors.initials: M
authors.lastname: Hayakawa
authors.affiliation: Department of Emergency Medicine and Critical Care, National Center For Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. Electronic address: ahagiwar@hosp.ncgm.go.jp.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hagiwara
authors.affiliation: Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: mune@twmu.ac.jp.
authors.forename: Munekazu
authors.initials: M
authors.lastname: Takeda
authors.affiliation: Trauma and Emergency Center, Fukaya Red Cross Hospital, 5-8-1 Kamishiba-West, Fukaya, Saitama 366-0052, Japan. Electronic address: caneco8639@yahoo.co.jp.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kaneko
authors.affiliation: Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama 359-8513, Japan. Electronic address: ds0711@ndmc.ac.jp.
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
authors.affiliation: Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. Electronic address: kudodaisuke@med.tohoku.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kudo
authors.affiliation: Emergency and Critical Care Center, Hokkaido University Hospital N14W5, Kita-ku, Sapporo 060-8648, Japan. Electronic address: kmaekawa@sapmed.ac.jp.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Maekawa
authors.affiliation: Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan. Electronic address: t-kane@qk2.so-net.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanemura
authors.affiliation: Department of Emergency & Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Electronic address: takayukishibusawa@gmail.com.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shibusawa
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: yhagi@qf6.so-net.ne.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hagihara
authors.affiliation: Department of Emergency and Critical Care Medicine, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan. Electronic address: shintarou0420@yahoo.co.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Furugori
authors.affiliation: Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo, Tokyo 113-8510, Japan. Electronic address: siris.accm@tmd.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiraishi
authors.affiliation: Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo, Tokyo 113-8510, Japan. Electronic address: murata.accm@gmail.com.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Murata
authors.affiliation: Department of Emergency Medicine and Critical Care, National Center For Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. Electronic address: mayama_g@hotmail.com.
authors.forename: Gou
authors.initials: G
authors.lastname: Mayama
authors.affiliation: Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: ayaguchi@twmu.ac.jp.
authors.forename: Arino
authors.initials: A
authors.lastname: Yaguchi
authors.affiliation: Department of Emergency & Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo-Ku, Tokyo 113-8603, Japan. Electronic address: s-kim.0-70-8@bird.ocn.ne.jp.
authors.forename: Shiei
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan. Electronic address: takasu_osamu@kurume-u.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Takasu
authors.affiliation: Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan. Electronic address: k-nishiyama@juntendo-urayasu.jp.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Nishiyama
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data; D003422:Critical Care; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D005340:Fibrinogen
keywords: Cut-off value; Fibrinogen; Glasgow coma scale; Heart rate; Massive transfusion; Sensitivity; Specificity; Systolic blood pressure; Trauma