HIGH D-DIMER LEVELS PREDICT A POOR OUTCOME IN PATIENTS WITH SEVERE TRAUMA REGARDLESS OF FIBRINOGEN LEVELS : A RETROSPECTIVE COHORT STUDY

Abstract

　　Introduction : Elevated D-dimer levels in trauma patients are one of indicators of hyperfibrinolysis during the early phase of trauma. We hypothesized that high D-dimer levels would predict a poor outcome in severe trauma patients regardless of fibrinogen levels on arrival. Methods : Patients with more than 10 units of red cell concentrate transfusion and/or death during the first 24 hours were classified with a poor outcome. Based on cut-off values for fibrinogen and D-dimer to differentiate the outcomes were compared. Results : In a stepwise logistic regression analysis, fibrinogen and D-dimer levels were statistically significant predictors of a poor outcome. Optimal cut-off values for fibrinogen and D-dimer of 190 mg/dL and 38 mg/L, respectively. Based on these values, patients were divided into four groups : low D-dimer/high fibrinogen, low D-dimer/low fibrinogen, high D-dimer/high fibrinogen, and high D-dimer/low fibrinogen. The survival rate in the high D-dimer/low fibrinogen group was lower than in the other three groups. Moreover, the survival rate in the high D-dimer/high fibrinogen group was statistically lower than that in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. Conclusions : High D-dimer levels on arrival are a strong predictor of poor outcome in severe trauma patients, regardless of fibrinogen levels.