PURPOSE: To evaluate the usefulness of the levels of fibrin degradation products (FDPs) and d-dimer (DD) in blood for reflecting the severity of trauma.
PATIENTS AND METHODS: We reviewed medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The relationships among Injury Severity Score, mean blood pressure, heart rate, hemoglobin, hematocrit, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, FDP, and DD on arrival were examined in those patients.
RESULTS: A total of 122 patients were included in this study. The coefficients of correlation of FDP (r = 0.710) and DD (r = 0.636) with Injury Severity Score were higher than those of other parameters. In addition, the areas under the receiver operating characteristic curve of FDP and DD were larger than those of other parameters (0.757 and 0.756, respectively). The cutoff value of FDP from the Youden index was 4.70 μg/mL, and the sensitivity and specificity values were 75.9% and 68.4%, respectively. The cutoff value of DD from the Youden index was 2.55 μg/mL, and the sensitivity and specificity values were 75.9% and 73.7%, respectively. There were four patients requiring more than 10 U of red blood cell transfusion within 24 hours after trauma (a unit of red blood cell transfusion is made from 200 mL of whole blood in Japan). In those four patients, the mean values of FDP and DD were 90.8 μg/mL (range, 5.7–160 μg/mL) and 45.3 μg/mL (range, 3.2–66.4 μg/mL), respectively, and those data were much higher than the mean of all patients. The mean values of FDP and DD in four patients who died were 244.6 μg/mL (range, 158.4–420 μg/mL) and 102.8 μg/mL (range, 32.8–240 μg/mL), respectively. Both FDP and DD in patients who died were remarkably elevated immediately after trauma.
CONCLUSION: FDP and DD levels may be useful parameters for initial evaluation of the severity of trauma, massive blood transfusion, and mortality.
LEVEL OF EVIDENCE: Prognostic/epidemiological study, level III
From the Department of Emergency Medicine (S.H., K.O., M.A., M.M., K.I., M.K., K.F., T.N.), Gunma University Graduate School of Medicine; Department of General Medicine (Y.O., J.T.), Gunma University Graduate School of Medicine; and Emergency and General Medical Center (S.H., K.O., M.A., M.M., M.K., K.F., T.N., Y.O., J.T.), Gunma University Hospital
Submitted: August 14, 2012; Revised: November 6, 2012; Accepted: November 8, 2012.
Address for reprints: Shuichi Hagiwara, MD, PhD, Assistant Professor, Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan; email: firstname.lastname@example.org.