The relationship between fibrinogen and ionized calcium values and mortality in patients admitted to the emergency department due to trauma

Objective: Trauma is recognized as one of the most serious health problems worldwide and in our country. According to reports by the World Health Organization, every minute, at least nine people lose their lives due to trauma, amounting to approximately 5.8 million people annually. Numerous studies are being conducted both in our country and globally to improve the diagnosis and treatment methods for trauma patients. In our research, we aim to conduct a comparative analysis on the effects of fibrinogen and ionized calcium on mortality in patients with multiple traumas, their contributions to trauma resuscitation, and the relationship between fibrinogen levels and ionized calcium. Materials and Methods: Our study was conducted after obtaining ethical approval from the Clinical Research Ethics Committee of Süleyman Demirel University Hospital. It took place between February 15, 2023, and October 15, 2023, at the Emergency Medicine Clinic of Süleyman Demirel University Hospital in Isparta, focusing on the prospective examination of patients over 18 years old who presented with multiple traumas. For the statistical analysis of the data we collected from our patients, we used SPSS IBM version 29 and Medcalc Statistical Software version 22.016. Results: Our study was conducted with 53 patients. Of the participants, 40 were male (75.5%) and 13 were female (24.5%). The ages of the patients included in our study ranged from 19 to 86 years, with an average age of 49.08±19.75. Examining the trauma mechanisms, traffic accidents were the most common, accounting for 69.8% (n=37), followed by falls at 26.4% (n=14). In terms of patient mortality, 24.5% (n=13) were deceased, while 75.5% (n=40) were discharged post-admission. The average fibrinogen level at the time of presentation was 221.85±74.95. A statistically significant relationship was found between fibrinogen levels and patient outcomes (p=0.002). When fibrinogen's impact on mortality was examined using ROC (Receiver Operating Characteristic) analysis, it showed a sensitivity of 76.9%, specificity of 70.0%, and an AUC (Area Under Curve) value of 0.788. The average ionized calcium level at presentation was 0.95±0.152. There was no statistically significant difference between calcium levels and patient mortality (p=0.756). ROC analysis of ionized calcium values showed a sensitivity of 92.3%, specificity of 40%, and an AUC value of 0.529. No correlation was found between fibrinogen and ionized calcium. The ICa/fibrinogen value's ROC analysis showed a sensitivity of 69.2%, specificity of 80.0%, and the p-value related to mortality was found to be 0.001. Conclusion: We found that in patients presenting with trauma, the fibrinogen value can be used to predict mortality, however, the ionized calcium value alone does not predict mortality. We also discovered that the ratios of ionized calcium/fibrinogen and ionized calcium/shock index can be used in predicting mortality. Keywords: Trauma, fibrinogen, ionized calcium, mortality