HIGH D-DIMER LEVELS PREDICT A POOR OUTCOME IN PATIENTS WITH SEVERE TRAUMA, EVEN WITH HIGH FIBRINOGEN LEVELS ON ARRIVAL: A MULTICENTER RETROSPECTIVE STUDY
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Mineji Hayakawa1, Kunihiko Maekawa, Shigeki Kushimoto
1*Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo†Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai‡Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center§Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo¶Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine||Senshu Trauma and Critical Care Center, Rinku General Medical Center#Department of Emergency and Critical Care Medicine, Kinki University Faculty of Medicine, Osaka**Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama††Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka‡‡Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine§§Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo¶¶Emergency and Critical Care Center, Fukaya Red Cross Hospital||||Division of Traumatology, Research Institute, National Defence Medical College, Saitama##Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine***Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo†††Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume‡‡‡Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan.
Elevated D-dimer level in trauma patients is associated with tissue damage severity and is an indicator of hyperfibrinolysis during the early phase of trauma. To investigate the interacting effects of fibrinogen and D-dimer levels on arrival at the emergency department for massive transfusion and mortality in severe trauma patients in a multicenter retrospective study. This study included 519 adult trauma patients with an injury severity score ≥16. Patients with ≥10 units of red cell concentrate transfusion and/or death during the first 24 h were classified as having a poor outcome. Receiver operating characteristic curve analysis for predicting poor outcome showed the optimal cut-off fibrinogen and D-dimer values to be 190 mg/dL and 38 mg/L, respectively. On the basis of these values, patients were divided into four groups: low D-dimer (<38 mg/L)/high fibrinogen (>190 mg/dL), low D-dimer (<38 mg/L)/low fibrinogen (≤190 mg/dL), high D-dimer (≥38 mg/L)/high fibrinogen (>190 mg/dL), and high D-dimer (≥38 mg/L)/low fibrinogen (≤190 mg/dL). The survival rate was lower in the high D-dimer/low fibrinogen group than in the other groups. Moreover, the survival rate was lower in the high D-dimer/high fibrinogen group than in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. High D-dimer level on arrival is a strong predictor of early death or requirement for massive transfusion in severe trauma patients, even with high fibrinogen levels.
Elevated D-dimer level in trauma patients is associated with tissue damage severity and is an indicator of hyperfibrinolysis during the early phase of trauma. To investigate the interacting effects of fibrinogen and D-dimer levels on arrival at the emergency department for massive transfusion and mortality in severe trauma patients in a multicenter retrospective study. This study included 519 adult trauma patients with an injury severity score ≥16. Patients with ≥10 units of red cell concentrate transfusion and/or death during the first 24 h were classified as having a poor outcome. Receiver operating characteristic curve analysis for predicting poor outcome showed the optimal cut-off fibrinogen and D-dimer values to be 190 mg/dL and 38 mg/L, respectively. On the basis of these values, patients were divided into four groups: low D-dimer (<38 mg/L)/high fibrinogen (>190 mg/dL), low D-dimer (<38 mg/L)/low fibrinogen (≤190 mg/dL), high D-dimer (≥38 mg/L)/high fibrinogen (>190 mg/dL), and high D-dimer (≥38 mg/L)/low fibrinogen (≤190 mg/dL). The survival rate was lower in the high D-dimer/low fibrinogen group than in the other groups. Moreover, the survival rate was lower in the high D-dimer/high fibrinogen group than in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. High D-dimer level on arrival is a strong predictor of early death or requirement for massive transfusion in severe trauma patients, even with high fibrinogen levels.
