{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:07:49Z","timestamp":1789193269247,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100022657","name":"Faculdade de Ci\u00eancias da Sa\u00fade, Universidade de Macau","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022657","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021510","name":"Department of Haematology, Christian Medical College, Vellore","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021510","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Fibrinogen deficiency is an important coagulation abnormality, with diverse causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A consecutive\u2010case cohort study of adult and pediatric patients with low Clauss fibrinogen at four acute care hospitals was undertaken to explore findings, causes, and predictors of outcomes, including the optimal fibrinogen critical value to predict all\u2010cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over 11\u2009months, 4.9% of tested patients (349\/7183, after excluding\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094 for preanalytical errors) had fibrinogen deficiency (63.6% male; 86.8% adult; 29.2% with liver disease; 14.0% with massive transfusion; 19.5% with fibrinogen &lt;\u20091.0\u2009g\/L, the historical critical value; none with a diagnosed inherited deficiency). Primary causes of fibrinogen deficiency were: cardiovascular surgery (CVS); trauma; overt, not overt and potential\/not scorable (no D\u2010dimer results) disseminated intravascular coagulation (DIC); liver disease; acute bleeding; and other (including uncertain) causes. After Bonferroni correction, overt and potential\/not scorable DIC were associated with significantly lower fibrinogen levels and higher mortality than most other causes were, particularly compared to trauma (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Median time to death after diagnosing fibrinogen deficiency was 1 (IQR: &lt;\u20091\u20137) day. A Clauss fibrinogen \u2264\u20091.3\u2009g\/L had optimal sensitivity and specificity for predicting mortality among fibrinogen\u2010deficient patients, and multivariate analyses indicated it was a strong, independent predictor of death (adjusted odds ratio [95% confidence intervals]: 6.2 [2.9\u201313.6] vs. \u2264\u20093.6 for liver disease and DIC). Spearman correlation indicated that the nadir Clauss fibrinogen level had a negative correlation (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) to the amount of fibrinogen replacement received.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low Clauss fibrinogen was commonly acquired and levels \u2264\u20091.3\u2009g\/L were optimal for predicting all\u2010cause mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijlh.70246","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:16:33Z","timestamp":1789190193000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is It Time to Raise the Threshold for Critically Low Fibrinogen? Insights From a Retrospective, Consecutive\u2010Case Cohort Study of Low Fibrinogen due to Various Causes"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9501-0468","authenticated-orcid":false,"given":"Natalie","family":"Mathews","sequence":"first","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"},{"name":"Division of Pediatric Hematology\u2010Oncology CHU Sainte\u2010Justine  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"CHU Sainte\u2010Justine Azrieli Research Center  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Department of Pediatrics, Faculty of Medicine Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Department of Clinical Laboratory Medicine OPTILAB Montr\u00e9al\u2010CHU Sainte\u2010Justine  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subia","family":"Tasneem","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mana","family":"Al Dawsari","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"},{"name":"Department of Pathology and Laboratory Medicine Ad\u2010Diriyah Hospital, 3rd Health Cluster, Health Holding Company, Ministry of Health  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3167-801X","authenticated-orcid":false,"given":"Keona","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"},{"name":"Population Health Research Institute David Braley Cardiac, Vascular and Stroke Research Institute  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmeen","family":"Abulkhair","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"},{"name":"Department of Pathology and Laboratory Medicine Ministry of Health, Cluster One  Madinah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6795-4760","authenticated-orcid":false,"given":"Guillame","family":"Par\u00e9","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"},{"name":"Department of Health Research Methods, Evidence and Impact McMaster University  Hamilton Ontario Canada"},{"name":"Hamilton Regional Laboratory Medicine Program  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siraj","family":"Mithoowani","sequence":"additional","affiliation":[{"name":"Department of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2843-0817","authenticated-orcid":false,"given":"Catherine P. 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