Fibrinogen as an early predictor of acute organ dysfunction in pelvic fractures.

Abstract

Pelvic fractures are associated with substantial morbidity and mortality, yet the prognostic value of initial fibrinogen levels remains underexplored. We conducted a global retrospective cohort study using data from the TriNetX Global Collaborative Network (2005-2025), with ≥30 days of follow-up. Patients with pelvic fractures and fibrinogen data were included. Propensity score matching adjusted for age, sex, race, ethnicity, comorbidities, and labs. Primary outcomes were mortality and complications in patients with fibrinogen ≤200 mg/dL compared to >200.01 mg/dL. Relative risks (RR) and number needed to harm (NNH) were calculated at 1, 3, 7, 14, and 30 days. Subgroup and sensitivity analyses tested robustness. 10,552 patients were included after matching, with 5276 patients in each cohort. The low fibrinogen group exhibited significantly higher risks of adverse outcomes at 30 days, including acute kidney injury (RR, 1.30; 95 % CI, 1.21-1.41; NNH: 18), shock (RR, 1.51; 95 % CI, 1.40-1.85; NNH: 12), respiratory failure (RR, 1.29; 95 % CI, 1.24-1.34; NNH: 9), acute respiratory distress syndrome (RR, 1.28; 95 % CI, 1.08-1.52; NNH: 84), disseminated intravascular coagulation (RR, 2.06; 95 % CI, 1.70-2.47; NNH: 32), and all-cause mortality (RR, 1.90; 95 % CI, 1.70-2.14; NNH: 15). These associations were consistent across subgroups stratified by age and sex, and held steady in sensitivity analyses using lower fibrinogen thresholds. A fibrinogen level of ≤ 200 mg/dL is associated with increased mortality and acute organ dysfunction in patients with pelvic fractures.