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Effect of low fibrinogen level on in-hospital mortality and 6-month functional outcome of TBI patients, a single center experience

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Abstract

In patients affected by traumatic brain injury (TBI), hypofibrinogenemia within the initial hours of trauma can be expected due to vascular and inflammatory changes. In this study, we aimed to evaluate the effect of hypofibrinogenemia on the in-hospital mortality and 6-month functional outcomes of TBI patients, admitted to Rajaee Hospital, a referral trauma center in Shiraz, Iran. This study included all TBI patients admitted to our center who had no prior history of coagulopathy or any systemic disease, were alive on arrival, and had not received any blood product before admission. On admission, hospitalization, imaging, and 6-month follow-up information of included patients were extracted from the TBI registry database. The baseline characteristics of patients with fibrinogen levels of less than 150 mg/dL were compared with the cases with higher levels. To assess the effect of low fibrinogen levels on in-hospital mortality, a uni- and multivariate was conducted between those who died in hospital and survivors. Based on the 6-month GOSE score of patients, those with GOSE < 4 (unfavorable outcome) were compared with those with a favorable outcome. A total of 3049 patients (84.3% male, 15.7% female), with a mean age of 39.25 ± 18.87, met the eligibility criteria of this study. 494 patients had fibrinogen levels < 150 mg/dl, who were mostly younger and had lower average GCS scores in comparison to cases with higher fibrinogen levels. By comparison of the patients who died during hospitalization and survivors, it was shown that fibrinogen < 150 mg/dl is among the prognostic factors for in-hospital mortality (OR:1.75, CI: 1.32:2.34, P-value < 0.001), while the comparison between patients with the favorable and unfavorable functional outcome at 6-month follow-up, was not in favor of prognostic effect of low fibrinogen level (OR: 0.80, CI: 0.58: 1.11, P-value: 0.19). Hypofibrinogenemia is associated with in-hospital mortality of TBI patients, along with known factors such as higher age and lower initial GCS score. However, it is not among the prognostic factors of midterm functional outcome.

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The first and corresponding authors have complete access to all of the study’s data. The final published article includes all data generated or analyzed during this research.

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Acknowledgements

We express our gratitude to the patients and their family members who actively participated in the follow-up session. Additionally, we extend our appreciation to our dedicated hospital staff, who are tirelessly working to provide the highest level of care to our patients.

Funding

The authors received no monetary compensation for their research, writing, or publication of this paper.

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Authors and Affiliations

  1. Trauma Research Center, Department of Neurosurgery, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

    Omid Yousefi, Amirmohammad Farrokhi, Reza Taheri, Hadis Ghasemi, Sina Zoghi, Asma Eslami, Amin Niakan & Hosseinali Khalili

  2. Institute of Biology and Medicine, Taras Shevchenko National University of Kyiv (KNU), Kyiv, Ukraine

    Hadis Ghasemi

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Contributions

OY, AF, and RT: Preparation of primary draft. HG, SZ, and AE: Data collection. HK, AN: Initial idea and supervision on manuscript preparation and final review.

Corresponding author

Correspondence to Hosseinali Khalili.

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Ethical approval

The current study was reviewed by the ethics committee of Shiraz University of Medical Sciences and approved with the ethics code of IR.SUMS.REC. 1396.S330. Patients or their visitors gave written informed consent for participation and dissemination at the time of admission. All data used in the current study was extracted from the trauma registry database, established with the ethics code of IR.SUMS.REC.1401.183.

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Yousefi, O., Farrokhi, A., Taheri, R. et al. Effect of low fibrinogen level on in-hospital mortality and 6-month functional outcome of TBI patients, a single center experience. Neurosurg Rev 47, 95 (2024). https://doi.org/10.1007/s10143-024-02326-y

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