Fibrinogen; a predictor of injury severity and mortality among patients with traumatic brain injury in Sub-Saharan Africa: a prospective study.

Autor:	Ssenyondwa JB; College of Health Sciences Makerere University., Kiryabwire J; Mulago National Referral Hospital., Kaddumukasa M; College of Health Sciences Makerere University., Michael D; Neurological and Behavioral Outcome Center, University Hospitals, Case Medical Center., Kamabu LK; College of Health Sciences Makerere University., Galukande M; College of Health Sciences Makerere University., Kaddumukasa M; College of Health Sciences Makerere University., Sajatovic M; Neurological and Behavioral Outcome Center, University Hospitals, Case Medical Center., Makumbi TK; College of Health Sciences Makerere University.
Jazyk:	angličtina
Zdroj:	Research square [Res Sq] 2023 Mar 01. Date of Electronic Publication: 2023 Mar 01.
DOI:	10.21203/rs.3.rs-2596161/v1
Abstrakt:	Introduction: Fibrinogen levels drop quicker than any other factors in severe trauma such as Traumatic Brain Injury (TBI). Contemporaneous studies show that fibrinogen concentrations < 2 g/L are strongly related to mortality. However, little is known regarding fibrinogen levels and TBI severity as well as mortality in sub-Saharan Africa. We therefore set out to determine whether fibrinogen levels are associated with TBI severity and seven days outcomes. Objectives: To determine the sensitivity and specificity of fibrinogen levels and the association with severity and mortality among TBI patients at Mulago Hospital. Methods: We prospectively enrolled 213 patients with TBI aged between 13 and 60 years of age and presenting within 24hrs of injury. Patients with pre-existing coagulopathy, concurrent use of anticoagulant or antiplatelet agents, pre-existing hepatic insufficiency, diabetes mellitus and who were pregnant were excluded. Fibrinogen levels were determined using the Clauss fibrinogen assay. Results: Majority of the patients were male (88.7%) and nearly half were aged 30 or less (48.8%). Fibrinogen levels less than 2g/L were observed in 74 (35.1%) of the patients while levels above 4.5 g/L were observed in 30(14.2%) of the patients. The average time spent in the study was 3.7 ± 2.4 days. The sensitivity and specificity using fibrinogen < 2g/L was 56.5% and 72.9% respectively. Fibrinogen levels predict TBI severity with an AUC = 0.656 (95% CI 0.58-0.73: p = 0.000) Fibrinogen levels < 2g/L (hypofibrinogenemia) were independently associated with severe TBI. (AOR 2.87 CI,1.34-6.14: p = 0.007). Levels above 4.5g/L were also independently associated with injury severity (AOR 2.89, CI 1.12-7.48: p < 0.05) Fibrinogen levels more than 4.5g/L were independently associated with mortality (OR 4.5, CI;1.47-13.61, p < 0.05). Conclusions: The fibrinogen level is a useful tool in predicting severity including mortality of TBI in our settings. We recommend the routine use of fibrinogen levels in TBI patient evaluations as levels below 2g/L and levels above 4.5g/L are associated with severe injuries and mortality. Competing Interests: Competing interests The authors declare that they have no competing interests
Databáze:	MEDLINE
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