Fibrinogen; A Predictor Of Injury Severity And Mortality Among Patients With Traumatic Brain Injury In Sub-Saharan Africa: A Prospective Study

Abstract

Introduction: Fibrinogen levels drop quicker than any other factors in severe trauma such as  Traumatic Brain Injury (TBI). Contemporaneous studies show that fibrinogen concentrations < 2  g/L are strongly related to mortality. However, little is known regarding fibrinogen levels and TBI  severity as well as mortality in sub-Saharan Africa. We, therefore, set out to determine whether fibrinogen levels are associated with TBI severity and seven days outcomes. Objectives: To determine the sensitivity and specificity of fibrinogen levels and the association with severity and mortality among TBI patients at Mulago Hospital.  Methods: We prospectively enrolled 213 patients with TBI aged between 13 to 60 years of age and presenting within 24hrs of injury. Patients with pre-existing coagulopathy, concurrent use of  anticoagulant agents, pre-existing hepatic insufficiency, diabetes mellitus and pregnant participants were excluded. Fibrinogen levels were determined using the Clauss fibrinogen assay.  Results: Fibrinogen levels less than 2g/L were observed in 35.1% of the patients while levels above 4.5 g/L were observed in 14.2% of the patients. The sensitivity and specificity using fibrinogen <2g/L were 56.5% and 72.9%. Fibrinogen levels predict TBI severity with an AUC =  0.656. Fibrinogen levels <2g/L and levels >4.5g/L were independently associated with severe  TBI. (OR 2.87 and 2.89 respectively). Fibrinogen levels more than 4.5g/L were independently associated with mortality. (OR 4.5). Conclusions: Fibrinogen is a useful tool in predicting severity including mortality of TBI in our settings. We recommend the routine use of fibrinogen levels in TBI patient evaluation as levels  below 2g/L and levels above 4.5g/L are associated with severe injuries and mortality.