A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury
A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury
复制标题
DOI：
10.1007/s00701-019-04010-3
复制
发表时间：
2019-09-01
影响因子：
2.4
通讯作者：
Yokota, Hiroyuki
中科院分区：
文献类型：
--
作者：
Nakae, Ryuta;Yokobori, Shoji;Yokota, Hiroyuki
背景创伤性脑损伤(TBI)与凝血功能障碍之间的关系已经确立。虽然在脑外伤中预防凝血障碍涉及到用新鲜冰冻血浆(FFP)补充凝血因子，但其有效性存在争议。我们研究了开始输注FFP后3h血浆纤维蛋白原浓度与预后的关系，并评估了与入院时D-二聚体水平的相关性。方法对380例严重孤立性颅脑损伤患者伤后1h内采血进行回顾性分析。入院时测定血浆纤维蛋白原和D-二聚体浓度，伤后3-4h再次测定血浆纤维蛋白原浓度。根据是否接受FFP输注将患者分为两组。伤后3h按纤维蛋白原水平分为高纤维蛋白原亚组150 mg/dL和低纤维蛋白原亚组150 mg/dL。对这些亚组的人口学、临床、放射学和实验室数据进行比较。结果输注FFP组出院时及伤后3个月格拉斯哥预后评分(GOS)明显低于未输血组。在接受FFP治疗的患者中，高纤维蛋白原亚组在出院时和损伤后3个月的GOS评分显著高于低纤维蛋白原亚组。入院时D-二聚体升高预示随后纤维蛋白原下降。结论颅脑损伤患者输注FFP时，伤后3h纤维蛋白原水平<150 mg/dL者预后较好。评估入院D-二聚体和追踪纤维蛋白原对于预防脑外伤患者的凝血障碍是至关重要的。
Background The association between traumatic brain injury (TBI) and coagulopathy is well established. While coagulopathy prophylaxis in TBI involves replenishing coagulation factors with fresh frozen plasma (FFP), its effectiveness is controversial. We investigated the relationship between plasma fibrinogen concentration 3 h after initiating FFP transfusion and outcomes and evaluated the correlation with D-dimer levels at admission. Methods We retrospectively examined data from 380 patients with severe isolated TBI with blood samples collected a maximum of 1 h following injury. Plasma fibrinogen and D-dimer concentrations were obtained at admission, and plasma fibrinogen concentration was again assessed 3-4 h following injury. The patients were divided into two groups based on whether or not they received FFP transfusion. Patients were also divided into subgroups according their fibrinogen level: >= 150 mg/dL (high-fibrinogen subgroup) or < 150 mg/dL (low-fibrinogen subgroup) 3 h after injury. Demographic, clinical, radiological and laboratory data were compared between these subgroups. Results Glasgow Outcome Scale (GOS) scores at discharge and 3 months after injury were significantly lower in the FFP transfusion group than in the FFP non-transfusion group. Among patients who received FFP, GOS scores at discharge and 3 months after injury were significantly higher in the high-fibrinogen subgroup than in the low-fibrinogen subgroup. Elevated admission D-dimer predicted subsequent fibrinogen decrease. Conclusions In FFP transfusion, fibrinogen level >= 150 mg/dL 3 h after injury was associated with better outcomes in TBI patients. Assessing the admission D-dimer and tracking the fibrinogen are crucial for optimal coagulopathy prophylaxis in TBI patients.