# The Associations Between Fibrinogen and Septic Shock in Critically Ill Patients With Sepsis: A Retrospective Cohort Study

## TL;DR

This study found that higher fibrinogen levels are linked to a greater risk of septic shock in sepsis patients, suggesting it could be a useful predictor.

## Contribution

The study demonstrates a strong, linear association between fibrinogen levels and septic shock risk in sepsis patients.

## Key findings

- Fibrinogen levels were significantly associated with septic shock (OR = 1.46; 95% CI, 1.35–1.56).
- Fibrinogen showed higher predictive accuracy (AUC = 0.78) than SOFA, SASP II, and APS II for septic shock.
- The risk of septic shock increased with higher fibrinogen levels (all p values for trend < 0.001).

## Abstract

Fibrinogen has been used as a prognostic indicator for sepsis. However, the associations of fibrinogen and septic shock in septic patients remain unclear. This study aimed to explore the relationship between fibrinogen levels and the occurrence of septic shock in patients with sepsis.

Data were retrospectively analyzed from the Medical Information Mart for Intensive Care IV (MIMIC‐IV v3.1) database. The Boruta algorithm and random forest model were used for feature selection to ensure the important variables affecting results. Multivariate logistic regression assessed the association between fibrinogen and septic shock. Subgroup analysis was conducted to evaluate the impact of additional variables on the results.

The study included 3302 septic patients. Fibrinogen was significantly associated with septic shock (odds ratio [OR] = 1.46; 95% confidence interval [CI], 1.35–1.56), and the risk of septic shock increased with higher fibrinogen levels (all p values for trend < 0.001). The ROC curve demonstrated the predictive accuracy of fibrinogen for septic shock in sepsis patients. After adjustment for demographics and laboratory, fibrinogen had a higher area under curve (AUC) value (0.78; 95% CI, 0.76–0.79) than SOFA (AUC, 0.58; 95% CI, 0.56–0.61), SASP II (AUC, 0.67; 95% CI, 0.65–0.69), and APS II (AUC, 0.69; 95% CI, 0.68–0.71).

A linear relationship was found between fibrinogen levels and septic shock. Elevated fibrinogen levels were linked to a higher risk of septic shock in septic patients.