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J Korean Soc Emerg Med > Volume 34(5); 2023 > Article
Journal of The Korean Society of Emergency Medicine 2023;34(5): 453-461.
Association between initial fibrinogen levels and adverse outcomes in emergency department patients with primary postpartum hemorrhage
Jae Hoon Lee , Chang Hwan Sohn , Youn-Jung Kim , Seung Mok Ryoo , Shin Ahn , Dong Woo Seo , Won Young Kim
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Correspondence  Chang Hwan Sohn ,Tel: 02-3010-3350, Fax: 02-3010-3360, Email: schwan97@gmail.com,
Received: September 26, 2022; Revised: October 26, 2022   Accepted: October 31, 2022.  Published online: October 31, 2023.
ABSTRACT
Objective:
This study evaluates the association between the initial fibrinogen levels and adverse outcomes in emergency department (ED) patients with primary postpartum hemorrhage (PPH).
Method:
This retrospective observational study was performed between January 2004 and December 2021 in the ED of a university-affiliated tertiary referral center. Primary PPH patients with fibrinogen level assessments in the ED were included. Patients were classified into two groups: the adverse outcome group-defined as patients receiving massive transfusion (transfusion of ≥10 units of packed red blood cells within the initial 24 hours), uterine artery embolization or emergency hysterectomy, intensive care unit admission, and in-hospital mortality-and the non-adverse outcome group.
Results:
Of the 481 patients included in the study, 276 (57.4%) had adverse outcomes. The median fibrinogen level in patients with adverse outcomes was lower than in patients without adverse outcomes-149.5 mg/dL (range, 66.8-228.8) vs. 288.0 mg/dL (range, 215.0-349.0), respectively; P<0.001. The area under the receiver operating characteristic curve of the initial fibrinogen level for adverse outcomes was 0.811 (95% confidence interval, 0.773-0.849; P<0.001). The occurrence of adverse outcomes increased with decreasing fibrinogen levels (P<0.001). When the cutoff value of the initial fibrinogen level was 400 mg/dL, the sensitivity and negative predictive values for predicting adverse outcomes were 98.6% and 84.6%, respectively. When the cutoff value of the initial fibrinogen level was 100 mg/dL, the specificity and positive predictive values were 96.6% and 92.8%, respectively.
Conclusion:
The initial fibrinogen levels on ED admission are associated with adverse outcomes.
Key words: Postpartum hemorrhage; Prognosis; Fibrinogen
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