Fibrinogen; a predictor of injury severity and mortality among patients with traumatic brain injury in Sub-Saharan Africa: A cross-sectional observational study.
Fibrinogen; a predictor of injury severity and mortality among patients with traumatic brain injury in Sub-Saharan Africa: A cross-sectional observational study.
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DOI：
10.1097/md.0000000000035685
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发表时间：
2023-10-20
期刊：
影响因子：
1.6
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中科院分区：
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研究表明，创伤性脑损伤（TBI）患者的纤维蛋白原浓度<2 g/L与死亡率增加相关。然而，关于纤维蛋白原水平和TBI的严重程度以及撒哈拉以南非洲地区的死亡率知之甚少，尽管他们承担着很高的TBI负担。因此，我们着手确定纤维蛋白原水平是否与TBI的严重程度和结果相关。确定Mulago医院TBI患者纤维蛋白原水平的敏感性和特异性以及与严重程度和死亡率的相关性。我们前瞻性地招募了213名年龄在13岁至60岁之间的TBI患者，这些患者在受伤后24小时内出现。排除了既存凝血病、同时使用抗凝剂或抗血小板药物、既存肝功能不全、糖尿病和妊娠患者。使用Clauss纤维蛋白原测定法测定纤维蛋白原水平。进行逻辑回归分析，以确定纤维蛋白原水平和7天的结果之间的关联。大多数患者为男性（88.7%），近一半的患者年龄在30岁或以下（48.8%）。在35.1%的研究参与者中观察到纤维蛋白原水平<2 g/L。在研究中花费的平均时间为3.7 ± 2.4天。 以纤维蛋白原<2g/L为诊断标准，敏感性为56.5%，特异性为72.9%。 纤维蛋白原水平预测TBI严重程度，AUC = 0.656（95%CI 0.58-0.73：P = 0.000）纤维蛋白原水平<2 g/L（低纤维蛋白原血症）与严重TBI独立相关。 （校正比值比2.87 CI，1.34-6.14：P =.007）。 高于4.5 g/L的水平也与损伤严重程度独立相关（校正比值比2.89，CI 1.12-7.48：P <.05）。纤维蛋白原水平高于4.5 g/L与死亡率独立相关（OR 4.5，CI; 1.47-13.61，P <.05）。 纤维蛋白原水平是预测TBI严重程度包括死亡率的有用工具。纤维蛋白原水平可用作筛选TBI患者损伤严重程度的额外工具，特别是在格拉斯哥昏迷量表评分<14的患者中。
Studies show that fibrinogen concentrations <2 g/L in patients with traumatic brain injury (TBI) is associated with increased mortality. However, little is known regarding fibrinogen levels and TBI severity as well as mortality in sub-Saharan Africa despite shouldering a high burden of TBI. We therefore set out to determine whether fibrinogen levels are associated with TBI severity and outcome. To determine the sensitivity and specificity of fibrinogen levels and the association with severity and mortality among TBI patients at Mulago Hospital. We prospectively enrolled 213 patients with TBI aged between 13 and 60 years of age and presenting within 24 hours of injury. Patients with preexisting coagulopathy, concurrent use of anticoagulant or antiplatelet agents, preexisting hepatic insufficiency, diabetes mellitus and who were pregnant were excluded. Fibrinogen levels were determined using the Clauss fibrinogen assay. Logistic regression analyses were conducted to identify the association between fibrinogen level and 7-day outcomes. Majority of the patients were male (88.7%) and nearly half were aged 30 or less (48.8%). Fibrinogen levels <2 g/L were observed in 35.1% of the study participants. The average time spent in the study was 3.7 ± 2.4 days. The sensitivity and specificity using fibrinogen <2 g/L was 56.5% and 72.9% respectively. Fibrinogen levels predict TBI severity with an AUC = 0.656 (95% CI 0.58–0.73: P = .000) Fibrinogen levels <2 g/L (hypofibrinogenemia) were independently associated with severe TBI. (Adjusted odds ratio 2.87 CI, 1.34–6.14: P = .007). Levels above 4.5 g/L were also independently associated with injury severity (adjusted odds ratio 2.89, CI 1.12–7.48: P < .05) Fibrinogen levels more than 4.5 g/L were independently associated with mortality (OR 4.5, CI; 1.47–13.61, P < .05). The fibrinogen level is a useful tool in predicting severity including mortality of TBI. Fibrinogen levels may be used as an additional tool to screen TBI patients for injury severity especially among patients with Glasgow coma scale scores of <14.