In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L−1, but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L−1 or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h. Prospective analysis of retrospectively collected data from a trauma registry (01/2011–12/2019). MFD-C was defined by a fibrinogenemia 1.51–1.99 g L−1 or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L−1 (HemoCue®), and base deficit > 5 mEq L−1. Data are expressed as count (%), median [IQR]. 1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19–36] vs. 24 [17–29]) and had more impaired vital signs (base deficit: 5.4 [3.6–7.8] vs. 3.8 [2.0–6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L−1 and < 2.0 g L−1, FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L−1, or a base deficit > 5.0 mEq L−1 received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06–1.82] for MFD-C, and 2.17 [1.48–3.19] for MFD-A5. Results were not modified after adjustment on the ISS. We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD.

中文翻译：

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哪些中度纤维蛋白原缺乏的受伤患者需要补充纤维蛋白原？

在严重受伤的患者中，当纤维蛋白原血症 < 1.5 g L-1 时建议补充纤维蛋白原，但一些团队建议使用更高的阈值（纤维蛋白原血症 < 2.0 g L-1 或 5 分钟时的 FIBTEM 凝块振幅 (A5) 值 < 11 mm ）。本研究的目的是确定中度纤维蛋白原缺乏 (MFD) 患者的某些入院特征是否与 24 小时时给予纤维蛋白原有关。从创伤登记处（01/2011-12/2019）回顾性收集数据的前瞻性分析。MFD-C 由 1.51–1.99 g L-1 的纤维蛋白原血症或从线性回归和 ROC 曲线分析确定的相应 FIBTEM-A5 值 (MFD-A5) 定义。根据以下入院参数描述纤维蛋白原的给药：休克指数 (SI) > 1，血红蛋白水平 < 110 g L-1 (HemoCue®)，碱基不足 > 5 mEq L-1。数据表示为计数 (%)、中位数 [IQR]。研究共纳入 1076 名患者，266 名（27%）患有 MFD-C，其中 122/266（46%）名接受了纤维蛋白原治疗。接受纤维蛋白原治疗的 MFD-C 患者受伤更严重（ISS：27 [19-36] vs. 24 [17-29]）并且生命体征受损更严重（基础缺陷：5.4 [3.6-7.8] vs. 3.8 [ 2.0–6.0]）。线性回归分析发现纤维蛋白原水平与 FIBTEM-A5 呈正相关（r：0.805）。对于纤维蛋白原水平 < 1.5 g L-1 和 < 2.0 g L-1，FIBTEM-A5 阈值为 6 mm（敏感性 85%，特异性 83%，AUC：0.934）和 9 mm（敏感性 84%，特异性 69%， AUC：0.874），分别。MFD-A5 值（185 名 (27%) 患者）被定义为 FIBTEM-A5 介于 7 和 9 mm 之间。超过 50% 的 MFD-C 患者呈现 SI > 1，血红蛋白水平 < 110 g L-1，或碱基不足 > 5.0 mEq L-1 接受了纤维蛋白原。使用纤维蛋白原 (SI > 1) 的相对风险 [95% CI] 对于 MFD-C 为 1.39 [1.06–1.82]，对于 MFD-A5 为 2.17 [1.48–3.19]。结果在国际空间站调整后没有修改。我们在本研究中表明休克参数与纤维蛋白原给药之间存在关联。需要进一步的研究来确定如何使用这些参数来指导 MFD 创伤患者的纤维蛋白原给药。我们在本研究中表明休克参数与纤维蛋白原给药之间存在关联。需要进一步的研究来确定如何使用这些参数来指导 MFD 创伤患者的纤维蛋白原给药。我们在本研究中表明休克参数与纤维蛋白原给药之间存在关联。需要进一步的研究来确定如何使用这些参数来指导 MFD 创伤患者的纤维蛋白原给药。