Objective@#This study evaluates the
association between the initial
fibrinogen levels and adverse outcomes in
emergency department (ED)
patients with primary
postpartum hemorrhage (PPH). @*
Methods@#This retrospective
observational study was performed between January 2004 and December 2021 in the ED of a
university-affiliated
tertiary referral center. Primary PPH
patients with
fibrinogen level assessments in the ED were included.
Patients were classified into two groups the adverse outcome group-defined as
patients receiving massive transfusion (transfusion of ≥10 units of packed
red blood cells within the initial 24 hours),
uterine artery embolization or
emergency hysterectomy,
intensive care unit admission, and
in-hospital mortality-and the non-adverse outcome group. @*Results@#Of the 481
patients included in the study, 276 (57.4%) had adverse outcomes. The median
fibrinogen level in
patients with adverse outcomes was lower than in
patients without adverse outcomes-149.5 mg/dL (range, 66.8-228.8) vs. 288.0 mg/dL (range, 215.0-349.0), respectively; P<0.001. The area under the
receiver operating characteristic curve of the initial
fibrinogen level for adverse outcomes was 0.811 (95%
confidence interval, 0.773-0.849; P<0.001). The occurrence of adverse outcomes increased with decreasing
fibrinogen levels (P<0.001). When the cutoff value of the initial
fibrinogen level was 400 mg/dL, the
sensitivity and
negative predictive values for predicting adverse outcomes were 98.6% and 84.6%, respectively. When the cutoff value of the initial
fibrinogen level was 100 mg/dL, the
specificity and
positive predictive values were 96.6% and 92.8%, respectively. @*Conclusion@#The initial
fibrinogen levels on ED admission are associated with adverse outcomes.