Effect of Fibrinogen concentrate administration on early mortality in traumatic hemorrhagic shock: a propensity score analysis

Authors: Hamada, S. R., Pirracchio, R., Jocelyn, B., Benlaldj, M. N., Meaudre, E., Leone, M., Pottecher, J., Abback, P. S., Gauss, T., Boutonnet, M., Cook, F., Garrigue, D., Lesache, F., Julie, J., Rouquette, A., and Duranteau, J.

Publication : J.Trauma Acute.Care Surg March 2020

Affilations: Université paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre, F-94275, Le Kremlin Bicêtre, France. CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris ; CESP, INSERM, Maison de Solenn, 97 boulevard de Port-Royal, 75014 Paris, France ; Department of Anesthesiology and Critical Care, AP-HP, Hôpital Européen Georges Pompidou, Université Paris Descartes, 20 rue Leblanc, 75015 Paris, France. Ecole polytechnique, Paris, France. Ecole polytechnique, Paris, France. Department of Anesthesiology and Critical Care, Military Teaching Hospital Sainte-Anne, Toulon, France, French Military Health Service Academy – Ecole du Val-de-Grace, Paris, France. Department of Anesthesiology and Critical Care, AP-HM, Aix Marseille Université, Hôpital Nord, 13015 Marseille, France. Hôpitaux Universitaires de Strasbourg, Department of Anesthesiology and Critical Care, 1 Avenue Molière, Strasbourg, France. (…)

Abstract: BACKGROUND: Fibrinogen concentrate is widely used in traumatic hemorrhagic shock despite weak evidence in the literature. The aim of the study was to evaluate the effect of fibrinogen concentrate administration within the first 6 hours on 24-hour all-cause mortality in traumatic hemorrhagic shock using a causal inference approach. METHODS: Observational study from a French multicenter prospective trauma registry. Hemorrhagic shock was defined as transfusion of 4 or more red-blood cells units within the first 6 hours after admission. The confounding variables for the outcome (24h all-cause mortality) and treatment allocation (fibrinogen concentrate administration within the first 6 hours) were chosen by a Delphi method. The propensity score was specified with a data-adaptive algorithm and a doubly-robust approach with inverse proportionality of treatment weighting allowed to compute the average treatment effect. Sensitivity analyses were performed. RESULTS: Of 14336 patients in the registry during the study period, 1027 in hemorrhagic shock were analyzed (758 receiving fibrinogen concentrate within 6 hours and 269 not receiving fibrinogen concentrate). The average treatment effect, expressed as a risk difference, was -0.031, 95% confidence interval (CI) [-0.]