Modelling the association between fibrinogen concentration on admission and mortality in patients with massive transfusion after severe trauma: an analysis of a large regional database

Scand J Trauma Resusc Emerg Med. 2018 Jul 9;26(1):55. doi: 10.1186/s13049-018-0523-0.


Background: The relationship between fibrinogen concentration and traumatic death has been poorly explored after severe trauma. Existing studies analysed this relationship in unselected trauma population, often considering fibrinogen concentration as a categorical variable. The aim of our study was to model the relationship between fibrinogen concentration and in-hospital mortality in severe trauma patients requiring massive transfusion using fibrinogen on admission as a continuous variable.

Methods: We designed a retrospective observational study based on prospectively collected data from 2009 to 2015 in seven French level-I trauma centres. All consecutive patients requiring a transfusion of at least 10 packed red blood cells (RBC) within 24 h were included. To assess the relationship between in-hospital death and fibrinogen concentration on admission, we performed generalized linear and additive models with death as a dependent variable. We also assessed the relationship between fibrinogen concentration below 1.5 g.L- 1 and potential predictors.

Results: Within the study period, 366 patients were included. A non-linear relationship was found between fibrinogen concentration and death. Graphical modelling of this relationship depicted a negative association between fibrinogen levels and death below a fibrinogen concentration of 1.5 g.L- 1. Predictors of low fibrinogen concentration (< 1.5 g.L- 1) were systolic blood pressure, Glasgow coma scale and haemoglobin concentration on admission.

Conclusions: A complex and robust approach for modelling the relationship between fibrinogen and mortality revealed a critical fibrinogen threshold of 1.5 g.L- 1 for severe trauma patients requiring massive transfusion. This trigger may guide the administration of procoagulant therapies in this context.

Keywords: Fibrinogen; Massive transfusion; Mortality; Severe trauma.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Afibrinogenemia / diagnosis*
  • Afibrinogenemia / mortality*
  • Afibrinogenemia / therapy
  • Blood Coagulation Tests
  • Blood Transfusion*
  • Female
  • Fibrinogen / metabolism*
  • Glasgow Coma Scale
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Trauma Centers
  • Wounds and Injuries / blood*
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / therapy
  • Young Adult


  • Fibrinogen