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Research Snapshot Theater: Hematology, Adult I

Goal-DiREcted Fibrinogen Replenishment in Bleeding Critically Ill Non-Trauma PatieNts

Monday, March 23, 2026
10:15 AM - 11:15 AM Central Time
Location: Connections Central - RST 04
  • BR

    Bingkui Ren, N/A (he/him/his)

    China (People's Republic)

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • yz

    yuping zhang, N/A

    MD
    Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China.

    Disclosure information not submitted.

  • zy

    ziyan ye, N/A

    MD
    Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China.

    Disclosure information not submitted.

  • sc

    siying chen, N/A

    MD
    Department of Intensive Care Medicine, Trauma Center, Peking University People's Hospital, Beijing, PR China.

    Disclosure information not submitted.

  • LX

    Lu Xu, N/A

    MD
    Data Science Support Center, Scientific Research Administration Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences, Beijing100730,P.R.China.

    Disclosure information not submitted.

  • lk

    lu ke, N/A

    MD
    Department of Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210093, Jiangsu, P. R. China

    Disclosure information not submitted.

  • yf

    yun fan, N/A

    MD
    Department of Hematology, Beijing Hospital,National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730，P. R. China

    Disclosure information not submitted.

  • cl

    chuanbao li, N/A

    MD
    Department of Clinical Laboratory, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730，P.R. China

    Disclosure information not submitted.

  • js

    jingchun song, N/A

    MD
    Departmentof Critical Care Medicine, the 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang 330002, Jiangxi, P.R. China

    Disclosure information not submitted.

  • kz

    kang zou, N/A

    MD
    Department of Critical Care Medicine, the First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi Province, 341000, the people’s Republic of China

    Disclosure information not submitted.

  • tl

    ting lin, N/A

    MD
    Department of Surgical Intensive Care Unit,the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China

    Disclosure information not submitted.

  • WP

    Weibang Pan, N/A

    MD
    Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, Jiangsu, China

    Disclosure information not submitted.

  • zj

    zhengying jiang, N/A

    MD
    Department of Critical Care Medicine, Chongqing University Cancer Hospital, Chongqing 404100, P. R. China

    Disclosure information not submitted.

  • ww

    weihai wei, N/A

    MD
    The First People's Hospital of Qinzhou

    Disclosure information not submitted.

  • jd

    jun duan, N/A

    MD
    Department of Critical Care Medicine, China-Japan Friendship Hospital，100029

    Disclosure information not submitted.

  • ld

    lin dou, N/A

    MD
    Emergency Department,  Tianjin Fifth Central Hospital, Peking University Binhai Hospital

    Disclosure information not submitted.

  • wS

    wensong Su, N/A

    MD
    Department of intensive care unit, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Disclosure information not submitted.

  • fg

    feng guo, N/A

    MD
    Department of Intensive Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016，Zhejiang，P. R.China

    Disclosure information not submitted.

  • ZD

    Zheng Duan, n/a

    MD
    Shengli Central Hospital

    Disclosure information not submitted.

  • zc

    zhigang chang, N/A

    PhD
    Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China.

    Disclosure information not submitted.

Introduction: Current guidelines lack consensus on fibrinogen replacement thresholds in critical hemorrhage. This study aims to establish evidence-based supplementation thresholds and optimal targets for ICU patients with major bleeding, providing a framework for individualized coagulation management.


Methods: This prospective multicenter cohort study enrolled 197 patients with severe hemorrhage and coagulopathy from 12 tertiary ICUs in China. Standardized systems collected demographics, laboratory parameters, and interventions. Analysis comprised two phases: (1) Restricted cubic spline (RCS) models evaluated nonlinear associations between baseline fibrinogen and outcomes (hemostasis, ICU mortality), identifying a critical threshold at 1.54 g/L; (2) Post-treatment fibrinogen peaks (within 72h) were stratified into subgroups based on prior MIMIC-IV validation: < 1.54 g/L (low-risk), 1.54–2.0 g/L (intermediate), 2.0–2.5 g/L (target), ≥2.5 g/L (high-level). Statistical analyses included Cochran-Armitage test (dose-response), Firth’s regression (small-sample bias correction), and Kruskal-Wallis tests with Benjamini-Hochberg FDR correction (FDR < 0.05; transfusion heterogeneity).


Results: We enrolled 197 patients with massive hemorrhage (treatment: n=98; control: n=99). Baseline data showed the treatment group had significantly greater blood loss (1735vs.967 mL, P=0.013), lower fibrinogen (1.49vs.2.04 g/L, P=0.001), and higher APACHE II scores (19.5vs.16.7, P=0.047). Pretreatment fibrinogen showed nonlinear associations with hemostasis and ICU mortality (both Pnon-linear < 0.001), identifying a critical threshold at 1.54 g/L. Post-treatment fibrinogen levels of 2.0-2.5 g/L achieved a hemostasis rate of 75%-80%; higher levels (2.5-3.5 g/L) showed slightly reduced efficacy. Mortality was 35% for levels < 1.5 g/L, significantly decreasing to 15% at 2.0-2.5 g/L, and approaching zero at 2.5-3.5 g/L. Post-treatment levels also showed nonlinear associations with outcomes (both Pnon-linear < 0.001), with a critical threshold at 2.5 g/L.


Conclusions: Fibrinogen levels predict outcomes in critically ill patients with massive hemorrhage. Initiation of fibrinogen supplementation is recommended when levels fall below 1.5g/L, targeting 2.0–2.5g/L as the optimal therapeutic window to improve prognosis.