The fibrinogen levels on admission is a predictive marker of the contrast extravasation on enhanced computed tomography in sacral fracture.

Szczegóły
Abstrakt

Tytuł:: The fibrinogen levels on admission is a predictive marker of the contrast extravasation on enhanced computed tomography in sacral fracture.
Autorzy:: Notani N; Department of Orthopaedic Surgery, Faculty of Medicine.
Miyazaki M; Department of Orthopaedic Surgery, Faculty of Medicine.
Kanezaki S; Department of Orthopaedic Surgery, Faculty of Medicine.
Ishihara T; Department of Orthopaedic Surgery, Faculty of Medicine.
Sakamoto T; Department of Orthopaedic Surgery, Faculty of Medicine.
Abe T; Department of Orthopaedic Surgery, Faculty of Medicine.
Kataoka M; Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan.
Tsumura H; Department of Orthopaedic Surgery, Faculty of Medicine.
Źródło:: Medicine [Medicine (Baltimore)] 2021 Mar 12; Vol. 100 (10), pp. e25056.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
MeSH Terms:: Extravasation of Diagnostic and Therapeutic Materials/*etiology
Fibrinogen/*analysis
Hemorrhage/*diagnosis
Sacrum/*injuries
Spinal Fractures/*complications
Adult ; Aged ; Aged, 80 and over ; Biomarkers/blood ; Contrast Media/administration & dosage ; Feasibility Studies ; Female ; Hemorrhage/blood ; Hemorrhage/etiology ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Observational Studies as Topic ; Patient Admission ; Prognosis ; ROC Curve ; Reference Values ; Retrospective Studies ; Sacrum/blood supply ; Sacrum/diagnostic imaging ; Spinal Fractures/blood ; Spinal Fractures/diagnosis ; Tomography, X-Ray Computed
References:: Bonnin JG. Sacral fractures and injuries to the cauda equina. J Bone Joint Surg 1945;27:113–27.
Yahata T, Suzuki T, Shindo M. Treatment of sacral fractures in pelvic ring injuries. J Jpn Assoc Surg Trauma 2015;29:36–42.
Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 1988;227:67–81.
Davis JW, Moore FA, McIntyre RC Jr, et al. Western trauma association critical decisions in trauma: management of pelvic fracture with hemodynamic instability. J Trauma 2008;65:1012–5.
Smith W, Williams A, Agudelo J, et al. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma 2007;21:31–7.
Kuo LW, Yang SJ, Fu CY, et al. Relative hypotension increases the probability of the need for angioembolisation in pelvic fracture patients without contrast extravasation on computed tomography scan. Injury 2016;47:37–42.
Juern JS, Milia D, Codner P, et al. Clinical significance of computed tomography contrast extravasation in blunt trauma patients with a pelvic fracture. J Trauma Acute Care Surg 2017;82:138–40.
Agolini SF, Shah K, Jaffe J, et al. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 1997;43:395–9.
Mucha P Jr, Welch TJ. Hemorrhage in major pelvic fractures. Surg Clin North Am 1988;68:757–73.
Aoki M, Hagiwara S, Tokue H, et al. Prediction of extravasation in pelvic fracture using coagulation biomarkers. Injury 2016;47:1702–6.
Kanda Y. Investigation of the freely available easy-to-use software ’EZR’ for medical statistics. Bone Marrow Transplant 2013;48:452–8.
Cullinane DC, Schiller HJ, Zielinski MD, et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. J Trauma 2011;71:1850–68.
Provenzale JM, Nelson RC, Vinson EN. Duke Radiology Review: Imaging, Differential Diagnosis, and Discussion. 2nd ed.Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2012;x 636 pp.
Hayakawa M, Sawamura A, Gando S, et al. Disseminated intravascular coagulation at an early phase of trauma is associated with consumption coagulopathy and excessive fibrinolysis both by plasmin and neutrophil elastase. Surgery 2011;149:221–30.
Sawamura A, Hayakawa M, Gando S, et al. Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality. Thromb Res 2009;124:608–13.
Gando S, Kameue T, Matsuda N, et al. Combined activation of coagulation and inflammation has an important role in multiple organ dysfunction and poor outcome after severe trauma. Thromb Haemost 2002;88:943–9.
Mauffrey C, Cuellar DO 3rd, Pieracci F, et al. Strategies for the management of haemorrhage following pelvic fractures and associated trauma-induced coagulopathy. Bone Joint J 2014;96-B:1143–54.
Hiippala ST, Myllyla GJ, Vahtera EM. Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg 1995;81:360–5.
Hiippala S. Replacement of massive blood loss. Vox Sang 1998;74: (Suppl 2): 399–407.
Schochl H, Cotton B, Inaba K, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care 2011;15:R265.
Chambers LA, Chow SJ, Shaffer LE. Frequency and characteristics of coagulopathy in trauma patients treated with a low- or high-plasma-content massive transfusion protocol. Am J Clin Pathol 2011;136:364–70.
Inaba K, Karamanos E, Lustenberger T, et al. Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. J Am Coll Surg 2013;216:290–7.
Hayakawa M, Gando S, Ono Y, et al. Fibrinogen level deteriorates before other routine coagulation parameters and massive transfusion in the early phase of severe trauma: a retrospective observational study. Semin Thromb Hemost 2015;41:35–42.
Notani N, Miyazaki M, Kanezaki S, et al. Fibrinogen level on admission is a predictive marker of the need for massive blood transfusion after pelvic fracture. Am J Emerg Med 2020;38:789–93.
Substance Nomenclature:: 0 (Biomarkers)
0 (Contrast Media)
9001-32-5 (Fibrinogen)
Entry Date(s):: Date Created: 20210317 Date Completed: 20210329 Latest Revision: 20230103
Update Code:: 20240105
PubMed Central ID:: PMC7969224
DOI:: 10.1097/MD.0000000000025056
PMID:: 33725892
: Czasopismo naukowe

Full Text Finder

Abstract: Sacral fracture is the most frequent posterior injury among unstable pelvic ring fractures and is prone to massive hemorrhage and hemodynamic instability. Contrast extravasation (CE) on computed tomography (CT) is widely used as an indicator of significant arterial bleeding. However, while CE is effective to detect significant arterial bleeding but negative result cannot completely rule out massive bleeding. Therefore, additional factors help to compensate CE for the prediction of early hemodynamically unstable condition.We evaluated the risk factors that predict CE on enhanced computed CT in patients with sacral fractures. Patients were classified into 2 groups: CE positive on enhanced CT of the pelvis [CE(+)] and CE negative [CE(-)]. We compared age, sex, injury severity score (ISS), systolic blood pressure (sBP), type of sacral fracture based on Denis classification, platelet (PLT), base excess, lactate, prothrombin time-international normalized ratio, hemoglobin (Hb), activated partial thromboplastin time, D-dimer, and fibrinogen between the 2 groups.A total of 82 patients were treated for sacral fracture, of whom 69 patients were enrolled. There were 17 patients (10 men and 7 women) in CE(+) and 52 patients (28 men and 24 women) in CE(-). Age, ISS, and blood transfusion within 24 hours were significantly higher in the CE(+) group than in the CE(-) group (P = .023, P < .001, P < .001). sBP, Hb, PLT, fibrinogen were significantly lower in the CE(+) group than in the CE(-) group (P < .001, P < .001, P < .001, P < .001). D-dimer and lactate were higher in the CE(+) group than in the CE(-) group (P = .036, P < .001) with significant differences. On multivariate analysis, the level of fibrinogen was an independent predictor of CE(+). The area under the curve value for fibrinogen was 0.88, and the optimal cut-off value for prediction was 199 mg/dL.The fibrinogen levels on admission can predict contrast extravasation on enhanced CT in patients with sacral fractures. The optimal cut-off value of fibrinogen for CE(+) prediction in sacral fracture was 199 mg/dL. The use of fibrinogen to predict CE(+) could lead to prompt and effective treatment of active arterial hemorrhage in sacral fracture.
Competing Interests: The authors have no conflicts of interest to disclose.
(Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Informacja