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Presentation Details
| Association of Peak Gamma Prime Fibrinogen Levels with Outcomes in Trauma Patients Lydia Buzzard1, Ali Oran2, Martin Schreiber3, David Farrell1. 1Donald D.Trunkey Center for Civilian and Combat Casualty Care, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.2Department of Surgery, Oregon Health & Science University, Portland, OR, USA.3Uniformed Services University of the Health Sciences, Bethesda, MD, USA |
Abstract
Background: Gamma prime fibrinogen (GPF) is an alternatively-spliced variant of fibrinogen that is disproportionately increased by inflammation. GPF showed significant associations with thrombotic cardiovascular diseases, including heart attack, stroke, and peripheral artery disease, presumably because of GPF's additional high affinity thrombin binding site that protects thrombin from inhibition by heparin/antithrombin. In addition, GPF levels are associated with SpO2 levels, the development of ARDS, the need for ventilator or ECMO interventions, and death in COVID-19 patients. GPF has been measured in traumatic brain injury patients and showed an association with clot strength, but the time course of GPF levels following trauma is unknown. Objectives: The objective of this study was to measure GPF levels to investigate longitudinal trends following traumatic injury and the associations of GPF with outcomes. Methods: This was an ancillary study to a prospective, observational, single institution study performed at a Level I trauma center. GPF was measured in plasma samples from 193 patients taken at admission, 8 hours, 48 hours, and 72 hours. Results: GPF levels generally showed an abrupt decrease within the first 8 hours after admission. Thereafter, GPF levels tended to increase for the next 72 hours. Overall trends showed that after the GPF drop at 8 hours, in many cases GPF rose higher than the initial admission levels. There were significant associations between peak GPF levels and ISS scores, as well as the number of days that patients were on a ventilator. GPF levels were significantly associated with SpO2levels, the aPTT, and total fibrinogen levels. Conclusions: The decrease in GPF levels at 8 hours after admission is consistent with consumption during ongoing coagulation due to the acute injury. The increases seen at 48 and 72 hours are consistent with an acute phase reaction due to an inflammatory response. The association between peak GPF levels and ISS score and ventilator days suggests that peak GPF levels may reflect the extent of inflammation due to traumatic injury.
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