Optimal fibrinogen threshold in non-traumatic massive bleeding: a multicenter retrospective observational study

doi:10.1186/s13054-026-05991-1

Hemodynamics, fluids & transfusion

Optimal fibrinogen threshold in non-traumatic massive bleeding: a multicenter retrospective observational study

Crit CarePublished 2 Apr 2026Retrospective cohort study

Main finding · Hospital mortalityResultOdds ratio 0.37 95% CI 0.25–0.57

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Authors' conclusion

In critically ill patients with non-traumatic massive bleeding, a post-treatment fibrinogen level of 2.0-2.5 g/L appears optimal, and 2.0 g/L may represent a potential therapeutic threshold.

Study context

Population: Adult ICU patients with non-traumatic massive bleeding and hypofibrinogenemia (fibrinogen <2.0 g/L), 12 centres in China, 2018–2025
Participants: 358 patients · 12 centres

Exposure: FIBmax ≥ 2.0 g/L vs FIBmax < 2.0 g/L
Outcome: Hospital mortality (primary predictor: FIBmax)

Methodological detailsmulticentre, multivariable logistic regression, restricted cubic splines, Bonferroni-corrected pairwise comparisons

Multicentre
Multivariable logistic regression
Restricted cubic splines
Bonferroni-corrected pairwise comparisons

Main finding

Hospital mortality

Odds ratio

0.37

95% CI 0.25–0.57

P < 0.001

By group

FIBmax ≥ 2.0 g/L10.1%

FIBmax < 2.0 g/L48.0%

FIBmax (per g/L increase)

OR 0.37 (95% CI 0.25–0.57); P < 0.001

Per g/L increase, as printed

As reported in the abstract

Overall hospital mortality: 74 (20.7%)

Observational data: associations, not effects.

Further findings

Outcome	Estimate	P value
Model performance after adding FIBmax to base modelBase model + FIBmax vs Base model	AUC 0.899 vs. 0.868	P = 0.017
Hospital mortality, adjacent FIBmax groups (pairwise)FIBmax 1.5-2.0 g/L vs FIBmax 2.0-2.5 g/L · only significant adjacent transition; Bonferroni correction	fold higher hospital mortality 3.23	P = 0.004

Model performance after adding FIBmax to base model — Hosmer-Lemeshow P: 0.096 vs. 0.031
Model performance after adding FIBmax to base model — NRI: 0.814
Model performance after adding FIBmax to base model — IDI: 0.076

Dose-response (restricted cubic spline)

Non-linear relationship, P for non-linearity: 0.026
Inflection point: 2.03 g/L

Hospital mortality, adjacent FIBmax groups (pairwise)

Mortality plateaued; no additional benefit above 2.5 g/L

Original publication

Optimal fibrinogen threshold in non-traumatic massive bleeding: a multicenter retrospective observational study. Crit Care. Published 2 April 2026. doi:10.1186/s13054-026-05991-1

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