Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study

Murat Haksever; Deniz Taşdemir; Refaettin Şahin; Selim Kandemir; Alp Koray Kinter

Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study

Abstract

Aims: To evaluate the predictive value of the fibrinogen-to-shock index (FSI) ratio for identifying severe placental abruption and to compare its performance with fibrinogen and shock index alone. Methods: This retrospective cohort study included 136 pregnant women diagnosed with placental abruption at a tertiary perinatology center. Patients were classified as having mild/moderate abruption (n=86) or severe abruption (n=50). Demographic, clinical, laboratory, maternal, and neonatal outcome data were analyzed. The shock index was calculated as heart rate divided by systolic blood pressure, and the FSI ratio was derived by dividing fibrinogen by shock index. Univariate and multivariate logistic regression analyses were performed to determine predictors of severe abruption. Receiver operating characteristic (ROC) analysis, Youden index-based cut-off analysis, and decision curve analysis were used to assess discriminative performance and clinical utility. Results: Patients with severe placental abruption had significantly lower hemoglobin and fibrinogen levels and a significantly higher shock index than those with mild/moderate abruption (all p<0.001). The FSI ratio was markedly lower in the severe group (p<0.001). In multivariate analysis, the FSI ratio remained the only independent predictor of severe placental abruption (adjusted OR 0.20, 95% CI 0.11-0.36; p<0.001). ROC analysis showed excellent predictive performance for the FSI ratio (AUC 0.970, 95% CI 0.930-0.997), with an optimal cut-off value of ≤2.89, yielding 94.0% sensitivity and 96.5% specificity. Decision curve analysis also demonstrated favorable net benefit across clinically relevant threshold probabilities. Conclusion: The FSI ratio is a simple, rapid, and effective marker for predicting severe placental abruption and may improve early risk stratification in clinical practice.

Keywords

Supporting Institution

The authors received no financial support for the research, authorship, or publication of this article.

Ethical Statement

This retrospective cohort study was conducted at Şanlıurfa Training and Research Hospital, a tertiary referral center for high-risk obstetric care. Pregnant women managed between 2023 to 2025 were evaluated through electronic medical records. Ethical approval was obtained from the Diyarbakır Gazi Yaşargil Training and Research Hospital Ethics Committee (Approval No: 75; Date: 02 March 2026). The study was performed in accordance with the Declaration of Helsinki and institutional research policies. Owing to the retrospective design and anonymized data collection, the requirement for written informed consent was waived by the ethics committee.

Thanks

The authors thank the clinical and perinatology unit staff of Ankara Bilkent City Hospital for their contribution to patient care and data recording.

References

Ananth CV, Lavery JA, Vintzileos et al. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol. 2016;214(2):272.e1-272.e9. doi:10.1016/j.ajog.2015.09.069
Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost. 2007;5(2):266-273. doi:10.1111/j.1538-7836.2007.02297.x
Wang L, Matsunaga S, Mikami Y, Takai Y, Terui K, Seki H. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption. J Obstet Gynaecol Res. 2016;42(7):796-802. doi:10.1111/jog.12988
Köroğlu N, Tayyar A, Soydar A, Albayrak N, Aydın T, Aslan ÇB. Pre-delivery fibrinogen level is a predictor for severity of placental abruption. Taiwan J Obstet Gynecol. 2023;62(6):1039-1043. doi:10.1016/j.eurox.2023.100264
Nathan HL, El Ayadi A, Hezelgrave NL, et al. Shock index: an effective predictor of outcome in postpartum haemorrhage? BJOG. 2015;122(2): 268-275. doi:10.1111/1471-0528.13206
Nathan HL, Cottam K, Hezelgrave NL, et al. Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: a prospective cohort study. Acta Obstet Gynecol Scand. 2019;98(9):1178-1186. doi:10.1111/aogs.13626
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837-845.
Collins GS, Reitsma JB, Altman DG, Moons KGM; members of the TRIPOD Group. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med. 2015;162(1):55-63. doi:10.7326/M14-0697

Details

Primary Language

English

Subjects

Obstetrics and Gynaecology

Journal Section

Research Article

Authors

Murat Haksever ^*
0000-0002-9526-3828
Türkiye

Deniz Taşdemir
0000-0002-0755-5338
Türkiye

Refaettin Şahin
0000-0002-5866-1798
Türkiye

Selim Kandemir
0000-0002-3951-3503
Türkiye

Alp Koray Kinter
0000-0003-3574-6649
Türkiye

Publication Date

August 15, 2026

Submission Date

March 30, 2026

Acceptance Date

June 30, 2026

Published in Issue

Year 2026 Volume: 7 Number: 4

IZ

https://izlik.org/JA47WT94PP

Cite

RIS / Bibtex

APA

Haksever, M., Taşdemir, D., Şahin, R., Kandemir, S., & Kinter, A. K. (2026). Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study. Journal of Medicine and Palliative Care, 7(4), 669-675. https://izlik.org/JA47WT94PP

AMA

1.Haksever M, Taşdemir D, Şahin R, Kandemir S, Kinter AK. Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study. J Med Palliat Care / JOMPAC / jompac. 2026;7(4):669-675. https://izlik.org/JA47WT94PP

Chicago

Haksever, Murat, Deniz Taşdemir, Refaettin Şahin, Selim Kandemir, and Alp Koray Kinter. 2026. “Fibrinogen-to-Shock Index Ratio As a Novel Predictor of Severity in Placental Abruption: A Retrospective Cohort Study”. Journal of Medicine and Palliative Care 7 (4): 669-75. https://izlik.org/JA47WT94PP.

EndNote

Haksever M, Taşdemir D, Şahin R, Kandemir S, Kinter AK (August 1, 2026) Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study. Journal of Medicine and Palliative Care 7 4 669–675.

IEEE

[1]M. Haksever, D. Taşdemir, R. Şahin, S. Kandemir, and A. K. Kinter, “Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 4, pp. 669–675, Aug. 2026, [Online]. Available: https://izlik.org/JA47WT94PP

ISNAD

Haksever, Murat - Taşdemir, Deniz - Şahin, Refaettin - Kandemir, Selim - Kinter, Alp Koray. “Fibrinogen-to-Shock Index Ratio As a Novel Predictor of Severity in Placental Abruption: A Retrospective Cohort Study”. Journal of Medicine and Palliative Care 7/4 (August 1, 2026): 669-675. https://izlik.org/JA47WT94PP.

JAMA

1.Haksever M, Taşdemir D, Şahin R, Kandemir S, Kinter AK. Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study. J Med Palliat Care / JOMPAC / jompac. 2026;7:669–675.

MLA

Haksever, Murat, et al. “Fibrinogen-to-Shock Index Ratio As a Novel Predictor of Severity in Placental Abruption: A Retrospective Cohort Study”. Journal of Medicine and Palliative Care, vol. 7, no. 4, Aug. 2026, pp. 669-75, https://izlik.org/JA47WT94PP.

Vancouver

1.Murat Haksever, Deniz Taşdemir, Refaettin Şahin, Selim Kandemir, Alp Koray Kinter. Fibrinogen-to-shock index ratio as a novel predictor of severity in placental abruption: a retrospective cohort study. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Aug. 1;7(4):669-75. Available from: https://izlik.org/JA47WT94PP