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High D-dimer levels predict a poor outcome in patients with severe trauma, even with high fibrinogen levels on arrival : a multicenter retrospective study

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Title: High D-dimer levels predict a poor outcome in patients with severe trauma, even with high fibrinogen levels on arrival : a multicenter retrospective study
Authors: Hayakawa, Mineji Browse this author →KAKEN DB
Maekawa, Kunihiko Browse this author
Kushimoto, Shigeki Browse this author →KAKEN DB
Kato, Hiroshi Browse this author
Sasaki, Junichi Browse this author
Ogura, Hiroshi Browse this author →KAKEN DB
Matauoka, Tetsuya Browse this author
Uejima, Toshifumi Browse this author
Morimura, Naoto Browse this author
Ishikura, Hiroyasu Browse this author
Hagiwara, Akiyoshi Browse this author
Takeda, Munekazu Browse this author
Kaneko, Naoyuki Browse this author
Saitoh, Daizoh Browse this author →KAKEN DB
Kudo, Daisuke Browse this author →KAKEN DB
Kanemura, Takashi Browse this author
Shibusawa, Takayuki Browse this author
Furugori, Shintaro Browse this author
Nakamura, Yoshihiko Browse this author
Shiraishi, Atsushi Browse this author
Murata, Kiyoshi Browse this author
Mayama, Gou Browse this author
Yaguchi, Arino Browse this author
Kim, Shiei Browse this author
Takasu, Osamu Browse this author
Nishiyama, Kazutaka Browse this author
Keywords: coagulopathy
disseminated intravascular coagulation
multiple trauma
fibrin fibrinogen degradation products
Issue Date: Mar-2016
Publisher: Lippincott Williams & Wilkins
Journal Title: Shock
Volume: 45
Issue: 3
Start Page: 308
End Page: 314
Publisher DOI: 10.1097/SHK.0000000000000542
PMID: 26882403
Abstract: Elevated D-dimer level in trauma patients is associated with tissue damage severity and is an indicator of hyperfibrinolysis during the early phase of trauma. To investigate the interacting effects of fibrinogen and D-dimer levels on arrival at the emergency department for massive transfusion and mortality in severe trauma patients in a multicentre retrospective study. This study included 519 adult trauma patients with an injury severity score ≥16. Patients with ≥10 units of red cell concentrate transfusion and/or death during the first 24 hours were classified as having a poor outcome. Receiver operating characteristic curve analysis for predicting poor outcome showed the optimal cut-off fibrinogen and D-dimer values to be 190 mg/dL and 38 mg/L, respectively. Based on these values, patients were divided into four groups: (1) low D-dimer (<38 mg/L)/high fibrinogen (>190 mg/dL), (2) low D-dimer (<38 mg/L)/low fibrinogen (≤190 mg/dL), (3) high D-dimer (≥38 mg/L)/high fibrinogen (>190 mg/dL), and (4) high D-dimer (≥38 mg/L)/low fibrinogen (≤190 mg/dL). The survival rate was lower in the high D-dimer/low fibrinogen group than in the other groups. Moreover, the survival rate was lower in the high D-dimer/high fibrinogen group than in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. High D-dimer level on arrival is a strong predictor of early death or requirement for massive transfusion in severe trauma patients, even with high fibrinogen levels.
Rights: This is a non-final version of an article published in final form in Shock, March 2016, Volume 45 Issue 3, pp. 308–314.
Type: article (author version)
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 早川 峰司

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