ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025
Association between fibrinogen levels and prognosis in critically bleeding patients: exploration of the optimal therapeutic threshold.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Fibrinogen Concentrate in Acute Hemorrhage: Mechanistic Insight, Thresholds, and Targeted Replacement.Journal of clinical medicine · 2026Review
- Prognostic value of the early D-dimer/fibrinogen ratio in critically ill patients requiring vascular surgery: a retrospective study.BMC anesthesiology · 2026Article
- Optimal fibrinogen threshold in non-traumatic massive bleeding: a multicenter retrospective observational study.Critical care (London, England) · 2026Observational
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6 authors.
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Abstract
backgroundSevere bleeding is a leading cause of ICU admission and mortality. Fibrinogen plays a crucial role in prognosis, yet optimal thresholds and supplementation targets remain unclear.
methodPatients with major bleeding were extracted from the MIMIC-IV database. Restricted cubic splines (RCS) identified the optimal pre-treatment fibrinogen threshold, and propensity score matching adjusted for confounders. Multiple analytical methods, including multivariable regression and machine learning models, were applied. Post-treatment fibrinogen levels were stratified based on guideline recommendations, and Cox regression assessed survival outcomes.
resultsAmong 7,063 patients (6,666 survivors, 397 non-survivors), RCS analysis revealed a nonlinear relationship between pre-treatment fibrinogen and ICU mortality (P-non-linear < 0.001), with a threshold at 1.3 g/L. Patients with Fib > 1.3 g/L had a significant 28-day survival benefit (OR = 0.65, 95% CI: 0.48-0.87, p < 0.01). Post-treatment stratification showed that fibrinogen ≥ 1.3 g/L was associated with improved survival (p < 0.01). RCS analysis identified an optimal post-treatment target of 2.0-2.5 g/L.
conclusionFibrinogen levels are predictive of ICU outcomes in massive hemorrhage. A pre-treatment threshold of 1.3 g/L indicates poor prognosis, while post-treatment levels of 2.0-2.5 g/L may optimize survival.
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