Clinical Significance of Fibrinogen Degradation Product Among Traumatized Patients

doi:10.1016/j.amj.2016.12.009

Air Medical Journal

Volume 36, Issue 2, March–April 2017, Pages 59-61

https://doi.org/10.1016/j.amj.2016.12.009 Get rights and content

Abstract

Objective

We retrospectively analyzed trauma patients who were transported by a physician-staffed helicopter (doctor helicopter) to investigate the clinical significance of the fibrinogen degradation product (FDP) level on arrival.

Methods

From February 2011 to July 2016, a medical chart review was retrospectively performed for all patients with trauma who were transported by the doctor helicopter. The subjects were divided into 2 groups: a survival group and a fatal group.

Results

There were 135 patients in the survival group and 16 in the fatal group. The ratio of head injury, value of Injury Severity Score (ISS), and level of FDP in the fatal group were significantly greater than in the survival group. The average Glasgow Coma Scale and systolic blood pressure in the fatal group were significantly smaller than in the survival group. The FDP level at arrival was positively associated with the ISS (R = 0.74, P < .0001). After excluding subjects with shock, unconsciousness, and head injury, the FDP level was still positively associated with the ISS (R = 0.60, P < .0001).

Conclusion

Therefore, the FDP level may be a useful biochemical parameter for the initial evaluation of the severity of trauma, even in blunt trauma patients without head injury or with stable vital signs.

Section snippets

Methods

The protocol of this retrospective study was approved by the review board of Numazu City Hospital and Juntendo Shizuoka Hospital, and all examinations were conducted in accordance with the standards of good clinical practice and the Helsinki Declaration.

Numazu City Hospital, which is a hospital with 426 beds and a medical emergency center in eastern Shizuoka Prefecture located near Tokyo, serves a population of approximately 190,000. The helicopter parks at Juntendo Shizuoka Hospital, and the

Results

During the investigation period, a total of 189 patients were transported to Numazu City Hospital by the DH. Among these patients, 37 did not have their FDP or D-dimer levels evaluated. After excluding these patients, a total of 151 patients were enrolled as subjects. There were 135 patients in the survival group and 16 in the fatal group. Among these 151 patients, 44 had their D-dimer levels assessed but not their FDP levels; therefore, the FDP level was calculated based on the D-dimer level.

Discussion

This is the first study to show that among trauma patients transported by the DH the level of consciousness, blood pressure, ISS, FDP level, base excess, and presence of head injury were associated with fatality. In addition, the FDP level at arrival had a positive correlation with anatomic traumatic severity.

Previous reports have revealed that FDP levels increase because of trauma and are correlated with the severity of the trauma.4, 7, 9 Concerning the mechanism of the positive correlation

Conclusion

Therefore, the FDP level may be a useful biochemical parameter for the initial evaluation of the severity of trauma, even in blunt trauma patients without head injury or with stable vital signs.

Acknowledgment

Supported by the Ministry of Education, Culture, Sports, Science and Technology (MEXT)-Supported Program for the Strategic Research Foundation at Private Universities, 2015-2019 concerning [The constitution of total researching system for comprehensive disaster, medical management, corresponding to wide-scale disaster].

References (15)

E. Suehiro et al.
Predictors of deterioration indicating a requirement for surgery in mild to moderate traumatic brain injury
Clin Neurol Neurosurg
(2014)
I. Raza et al.
The incidence and magnitude of fibrinolytic activation in trauma patients
J Thromb Haemost
(2013)
J. Cade et al.
The effect of experimental hematoma on serum levels of fibrinogen-related antigen
Blood
(1976)
B.M. Selladurai et al.
Coagulopathy in acute head injury–a study of its role as a prognostic indicator
Br J Neurosurg
(1997)
V. Saggar et al.
Hemostatic abnormalities in patients with closed head injuries and their role in predicting early mortality
J Neurotrauma
(2009)
L.D. Zhang et al.
Correlation analysis between plasma D-dimer levels and orthopedic trauma severity
Chin Med J (Engl)
(2012)
S. Hagiwara et al.
Usefulness of fibrin degradation products and d-dimer levels as biomarkers that reflect the severity of trauma
J Trauma Acute Care Surg
(2013)

There are more references available in the full text version of this article.

Cited by (6)

The impact of neutrophil extracellular traps on deep venous thrombosis in patients with traumatic fractures
2021, Clinica Chimica Acta
Citation Excerpt :
Previous reports have revealed that FDP and DD are easily measured and commonly considered the best available laboratory markers of coagulation activation and those levels have been found to correlate with the extent of thrombosis[38]. In addition, some studies have found that the levels of FDP increase after trauma are correlated with the severity of the trauma[39]. The elevated levels of FDP in trauma patients in our study were consistent with the findings of previous studies.
Deep venous thrombosis (DVT) is the most common complication in patients with traumatic fractures. The neutrophil extracellular traps (NETs) can promote thrombus formation. In this prospective study, we investigated the role of NETs in thrombosis in patients with traumatic fractures to evaluate whether the biomarkers of NETs can be used to help predict the risk of thrombosis.
Traumatic fracture patients were enrolled in this prospective observational cohort study. Healthy controls (Control); patients with lower extremity fractures who neither present with nor develop DVT (Trauma non-DVT); patients with lower extremity fractures who do not present with DVT but do develop DVT (Trauma DVT); and patients with lower extremity fractures who present with DVT (DVT) were included. NETs biomarker levels of Citrullinated Histone H3 (H3Cit), cell-free DNA (cfDNA) and nucleosomes in the plasma were determined. The D-dimer and fibrin(-ogen) degradation products (FDP) level in plasma was measured. Statistical analysis of the test results was performed to assess changes in NETs biomarker levels during thrombosis in patients with traumatic fractures.
The H3Cit levels in the DVT group were significantly greater than in the Trauma non-DVT group and Trauma DVT group (1.88(1.11, 3.35) ng/ml Vs 0.38(0.10, 1.17) ng/ml, P ≤ 0.05). The level of cfDNA was significantly greater in patients with traumatic fractures and was higher after thrombosis than before. The levels of D-dimer in the DVT, Trauma DVT, and Trauma non-DVT groups were significantly greater than in the Control group (5.11(3.97, 8.11) mg/l; 6.12(2.59, 18.49) mg/l; 2.99(0.99, 9.02) mg/l Vs 0.18(0.08,0.24) mg/l, P < 0.05). The distribution of FDP levels in each group was similar to that of D-dimer. Data are presented as medians (25th percentile, 75th percentile).
NETs released by neutrophils are involved in the formation of DVTs in patients with traumatic fractures. H3Cit and cfDNA can assist the diagnosis of DVT in patients with traumatic fractures.
An Analysis of Intoxicated Patients Transported by a Doctor Helicopter
2018, Air Medical Journal
We retrospectively investigated all of the intoxicated patients who were transported by a doctor helicopter (DH) in eastern Shizuoka between April 2004 and December 2015 to determine when air medical transport was used in cases of toxic exposure.
Subjects were divided into 2 groups: an outpatient group of subjects who went home after receiving a medical evaluation and treatment and an admission group.
The outpatient and admission groups included 17 and 31 subjects, respectively. The ratio of dispatching the DH to the scene and the median Glasgow Coma Scale score in the outpatient group were greater, and the shock index in the outpatient group was significantly smaller than in the admission group. The duration from exposure of intoxicated agents to contact by staffs of the DH in the outpatient group was also smaller than in the admission group.
The level of consciousness and shock index may be important factors dictating whether or not to dispatch the DH in order to prevent secondary damage induced by unstable circulation.
Development of a delirium predictive model for adult trauma patients in an emergency and critical care center: A retrospective study
2021, Trauma Surgery and Acute Care Open
Fibrinogen
2020, Trauma Induced Coagulopathy
Data quality of Glasgow Coma Scale and Systolic Blood Pressure in scientific studies involving physician-staffed emergency medical services: Systematic review
2020, Acta Anaesthesiologica Scandinavica
Platelets and Fibrinogen: Emerging Complexity in Trauma-Induced Coagulopathy
2020, Seminars in Thrombosis and Hemostasis

View full text

Original ResearchClinical Significance of Fibrinogen Degradation Product Among Traumatized Patients

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgment

Clin Neurol Neurosurg

J Thromb Haemost

Blood

Coagulopathy in acute head injury–a study of its role as a prognostic indicator

Br J Neurosurg

Hemostatic abnormalities in patients with closed head injuries and their role in predicting early mortality

J Neurotrauma

Correlation analysis between plasma D-dimer levels and orthopedic trauma severity

Chin Med J (Engl)

Usefulness of fibrin degradation products and d-dimer levels as biomarkers that reflect the severity of trauma

J Trauma Acute Care Surg

Original Research
Clinical Significance of Fibrinogen Degradation Product Among Traumatized Patients