Decreasing Plasma Fibrinogen Levels in the Intensive Care Unit Are Associated with High Mortality Rates In Patients...

Area of Science:

• Critical Care Medicine
• Hematology
• Infectious Diseases

Background:

• Plasma fibrinogen levels typically rise during infection but can decrease due to consumption or degradation in severe coagulopathy.
• Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, often involving coagulation abnormalities.
• C-reactive protein (CRP) is a key inflammatory marker, with levels over 5.00 mg/dL indicating significant inflammation in septic patients.

Purpose of the Study:

• To investigate the association between plasma fibrinogen level trends and clinical outcomes in patients with sepsis.
• To evaluate the relationship between fibrinogen dynamics, platelet count changes, and mortality rates in septic patients.
• To assess the prognostic value of fibrinogen trends in sepsis, particularly in patients with non-overt disseminated intravascular coagulation (DIC).

Main Methods:

• Sixty patients with sepsis and CRP levels > 5.00 mg/dL were enrolled.
• Patients were categorized into three groups based on fibrinogen concentration changes from day 0 to day 3: downtrend, flat trend, and uptrend.
• Platelet counts, inflammatory markers, and 28-day mortality rates were compared across the groups. Diagnoses of non-overt DIC were also recorded.

Main Results:

• The downtrend and flat trend groups exhibited reduced inflammatory markers by day 3.
• The downtrend group showed significantly greater platelet loss (108 vs 42 x 10^3/μL, p=0.026) and a higher mortality rate (46.7% vs 10.0%, p=0.027) compared to the flat trend group.
• Among patients diagnosed with non-overt DIC on day 0, those in the downtrend group had a higher mortality rate (41.7%) than those in the uptrend group (11.1%).

Conclusions:

• Decreasing plasma fibrinogen levels in intensive care unit (ICU) patients with sepsis are strongly associated with increased mortality.
• This association is further linked to significant decreases in platelet counts, even in the presence of non-overt disseminated intravascular coagulation (DIC).
• Fibrinogen level trends serve as a critical prognostic indicator for sepsis outcomes, emphasizing the importance of monitoring coagulation status.