Coagulation biomarkers as predictors of transfusion outcomes in trauma patients.

Objective: To investigate the role of coagulation biomarkers (fibrinogen [FIB], fibrin degradation products [FDP], D-dimer [D-D], FDP/FIB ratio) in predicting transfusion outcomes in trauma patients.

Methods: A retrospective analysis of 112 trauma cases (May 2020-May 2024) stratified into good (n=80) and poor prognosis (n=32) groups based on transfusion outcomes was conducted. Pre-transfusion levels of coagulation biomarkers were compared between groups. Pearson correlation assessed associations among markers, and logistic regression identified outcome predictors. Clinical parameters, including blood pressure, complete blood count, and coagulation function, were also considered. The predictive value was evaluated through receiver operating characteristic curve analysis.

Results: The poor prognosis group exhibited lower FIB but higher FDP, D-D, FDP/FIB ratio, and white blood cell count (WBC) (all P<0.01). Additionally, this group had longer prothrombin time and activated partial thromboplastin time (both P<0.01) as well as greater plasma transfusion volumes (P<0.05). An inverse relationship was identified between FIB and FDP/D-D levels across prognosis groups. However, positive FDP/D-D correlation was observed only in the poor prognosis group, with no significant FDP/D-D linkage found in the good prognosis group; moreover, these correlations were stronger in cases with worse clinical outcomes. Multivariate analysis identified FIB, FDP, D-D, and WBC as independent predictors. The combined biomarker model (area under the curve (AUC) =0.923) outperformed individual markers (AUC range: 0.691-0.809).

Conclusion: FIB, FDP, D-D, and WBC are significant predictors of transfusion outcomes in trauma patients. A combined biomarker model demonstrates superior predictive performance, highlighting the importance of identifying coagulation dysregulation in trauma prognosis.