Effect of early hemostasis strategy on secondary post-traumatic sepsis in trauma hemorrhagic patients

Wei Shang; Yuan Cao; Yun Li; Mingzi Ma; Hebin Che; Pan Xiao; Yang Yu; Hongjun Kang; Deqing Wang

doi:10.1016/j.injury.2023.111205

Effect of early hemostasis strategy on secondary post-traumatic sepsis in trauma hemorrhagic patients

Injury. 2024 Feb;55(2):111205. doi: 10.1016/j.injury.2023.111205. Epub 2023 Nov 14.

Authors

Wei Shang¹, Yuan Cao², Yun Li³, Mingzi Ma⁴, Hebin Che⁵, Pan Xiao⁶, Yang Yu¹, Hongjun Kang³, Deqing Wang⁷

Affiliations

¹ Medical School of Chinese PLA, Beijing, China; Department of Blood Transfusion Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
² Emergency Department, the Second Hospital of Hebei Medical University, Shijiazhuang, China.
³ Medical School of Chinese PLA, Beijing, China; Department of Critical Care Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
⁴ Department of Blood Transfusion, Shenyang Women's and Children's Hospital, Shenyang, China.
⁵ Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China.
⁶ Department of Blood Transfusion Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China; Department of Blood Transfusion, Affiliated Hospital of Southwest Medical University, Luzhou, China.
⁷ Medical School of Chinese PLA, Beijing, China; Department of Blood Transfusion Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China. Electronic address: deqingw@vip.sina.com.

PMID: 38006781
DOI: 10.1016/j.injury.2023.111205

Abstract

Introduction: Fibrinogen and platelet, as the two main components of hemostatic resuscitation, are frequently administered in traumatic massive hemorrhage patients. It is reasonable to infer that they may have an impact on post-traumatic sepsis as more and more recognition of their roles in inflammation and immunity. This study aims to determine the association between the fibrinogen/platelet transfusion ratio during the first 24 h after trauma and the risk of the post- traumatic sepsis.

Methods: We analyzed the data from the National Trauma Data Bank (NTDB). Subjects included the critically injured adult patients admitted to Level I/II trauma center from 2013 to 2017 who received fibrinogen and platelet supplementation and more than 10 units (about 4000 ml) packed red blood cells (pRBCs) during the first 24 h after trauma. Two parts of analyses were performed: (1) multivariable stepwise regression was used to determine the variables that influence the risk of post-traumatic sepsis; (2) propensity score matching (PSM), to compare the influences of different transfusion ratio between fibrinogen and platelet on the risk of sepsis and other outcomes after trauma.

Results: 8 features were screened out by bi-directional multivariable stepwise logistic regression to predict the post-traumatic sepsis. They are age, sex, BMI, ISS_abdomen, current smoker, COPD, Fib_4h/24h and Fib/PLT_24h. Fib/PLT_24h was negatively related to sepsis (p < 0.05). A total of 1601 patients were included in the PSM cohort and grouped by Fib/PLT_24h = 0.025 according to the fitting generalized additive model (GAM) model curve. The incidence of sepsis was significantly decreased in the high Fib/PLT group [3.3 % vs 9.4 %, OR = 0.33, 95 %CI (0.17-0.60)]; the length of stay in ICU and mechanical ventilation were both shortened as well [8 (IQR 2.00,17.00) vs 9 (IQR 3.00,19.25), p = 0.006 and 4 (IQR 2.00,10.00) vs 5 (IQR 2.00,14.00), p = 0.003, respectively.

Conclusions: Early and sufficient supplementation of fibrinogen was a convenient way contribute to reduce the risk of sepsis after trauma.

Keywords: Fibrinogen; Hemorrhagic shock; Hemostasis strategy; Massive transfusion protocol; Platelet; Post-traumatic sepsis; Trauma.

MeSH terms

Adult
Fibrinogen
Hemorrhage / etiology
Hemorrhage / therapy
Hemostasis
Hemostatics*
Humans
Platelet Transfusion
Retrospective Studies
Sepsis* / therapy
Wounds and Injuries* / complications
Wounds and Injuries* / therapy

Substances

Fibrinogen
Hemostatics