入院时纤维蛋白(原)降解产物与纤维蛋白原的比值与严重创伤患者早期不良预后的相关性

The relationship between the ratio of fibrin(ogen) degradation product (FDP) to fibrinogen (FIB) at admission and early poor prognosis in the patients with severe trauma

目的 研究严重创伤患者入院时纤维蛋白(原)降解产物(fibrin degradation product,FDP)与纤维蛋白原(fibrinogen,FIB)比值与早期不良预后的关系。方法 回顾性分析2020年1月至2022年1月收治的创伤严重程度(injury severity score,ISS)≥16分的严重创伤患者206例,按照是否存在24 h内大量输血和死亡分为预后不良组和预后良好组。研究入院时FDP/FIB比值与严重创伤患者预后的关系。结果 与预后良好组比较,预后不良组APTT更长(s:28.0 vs.30.5,P=0.003),PT更长(s:12.3 vs.12.6,P=0.044),FIB水平更低(mg/dL:2.3 vs.1.8,P=0.000),FDP水平更高(mg/L:75vs.185,P=0.000),D-二聚体水平更高(mg/L:8.5vs.22.9,P=0.000),FDP/FIB比值更高(34.7 vs.105.0,P=0.000)。FDP/FIB比值预测严重多发伤患者不良预后的ROC曲线下面积最大(AUC 0.772,95%CI 0.695~0.849),敏感度最高(86.8%),高于APTT、FDP、FIB、D-二聚体。结论 入院时FDP/FIB比值对严重创伤患者早期死亡和24 h内需大量输血的预测能力高于其他凝血生物标志物。

Objective To study the relationship between the ratio of fibrin(ogen) degradation product(FDP) to fibrinogen(FIB) at admission and early poor prognosis in the patients with severe trauma.Methods 206 patients of severe trauma with injury severity score(ISS)≥16 from January 2020 to January 2022 were retrospectively analyzed,and were divided into poor prognosis group and good prognosis group according to whether there was 24-hour massive blood transfusion and death.The relationship between the ratio of FDP/FIB at admission and the prognosis of patients with severe trauma was analyzed.Results Compared with the patients with good prognosis,the patients with poor prognosis had a longer activated partial thromboplastin time(APTT)(s:28.0 vs.30.5,P=0.003),longer prothrombin time(PT)(s:12.3 vs.12.6,P=0.044),lower FIB levels(mg/dL:2.3 vs.1.8,P=0.000) and higher FDP levels(mg/L:75 vs.185,P=0.000),higher D-dimer levels(mg/L:8.5 vs.22.9,P=0.000) and higher FDP/FIB values(34.7 vs.105.0,P=0.000).The area under the ROC curve for FDP/FIB to predict poor prognosis in the patients with severe multiple injuries was largest(AUC 0.772,95%CI 0.695-0.849),which was higher than APTT,FDP,FIB,and D-dimer.Conclusions The FDP/FIB ratio at admission is more predictive of early mortality and massive transfusion within 24 h in the patients with severe trauma than other coagulation biomarkers.