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KMID : 0385920230340050453
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Journal of the Korean Society of Emergency Medicine
2023 Volume.34 No. 5 p.453 ~ p.461
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Association between initial fibrinogen levels and adverse outcomes in emergency department patients with primary postpartum hemorrhage
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Lee Jae-Hoon
Sohn Min-Kyun
Kim Youn-Jung
Ryoo Seung-Mok
Ahn Shin
Seo Dong-Woo
Kim Won-Young
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Abstract
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Objective: This study evaluates the association between the initial fibrinogen levels and adverse outcomes in emergency department (ED) patients with primary postpartum hemorrhage (PPH).
Methods: 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.
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KEYWORD
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Postpartum hemorrhage, Prognosis, Fibrinogen
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