Background
Methods
Study design
Patient selection and criteria
Blood sampling and measurement
Statistical analysis
Results
Characteristics of patients enrolled (Table 1)
ALL (n = 39) | ADAMTS13 activity on day 0 | |||||
---|---|---|---|---|---|---|
50% > (n = 6) | 50%≤, 70% > (n = 20) | 70% ≤ (n = 13) | P value | |||
Patient characteristics | ||||||
Age | years | 61 (38–73) | 71 (67–72) | 65 (45–77) | 35 (23–56) | 0.017 |
Sex; male / female | n, (%) | 26 (66.7) / 13 (33.3) | 4 (66.7) / 2 (33.3) | 13 (65.0) / 7 (35.0) | 9 (69.2) / 4 (30.8) | 0.969 |
Injury Severity Score | 20 (10–27) | 17 (13–27) | 20 (11–28) | 20 (10–26) | 0.760 | |
JAAM DIC (+) | n, (%) | 11 (28.4) | 4 (66.7) | 5 (25.0) | 2 (15.4) | 0.063 |
Duration of injury to blood sampling | ||||||
minutes | 68 (31–180) | 43 (31–136) | 121 (44–261) | 41 (28–92) | 0.134 | |
Laboratory data [normal range] | ||||||
HGB [11.3–15.2] | g/dL | 12.8 (11.8–13.6) | 12.0 (10.3–12.2) | 12.0 (10.9–12.9) | 13.6 (13.3–14.8) | < 0.001 |
PLT [13.1–36.9] | ×104/μL | 21.6 (16.8–25.3) | 12.6 (9.3–18.1) | 21.2 (16.7–24.0) | 25.3 (21.2–26.6) | 0.015 |
PT [80.0–120.0] | % | 84.1 (77.6–97.7) | 72.6 (58.8–80.2) | 84.1 (80.4–96.6) | 90.8 (82.5–114.7) | 0.028 |
APTT [21.5–43.1] | sec | 24.7 (23.2–27.1) | 26.6 (24.9–30.2) | 24.9 (23.5–27.3) | 23.3 (22.2–26.5) | 0.101 |
HPT [70.0–130.0] | % | 112.7 (91.6–126.8) | 85.2 (70.8–91.4) | 110.4 (98.9–125.5) | 126.4 (101.9–139.9) | 0.003 |
Fbg [200–400] | mg/dL | 238 (187–280) | 214(181–272) | 230 (185–261) | 257 (235–304) | 0.450 |
FDP [< 5.0] | μg/mL | 63.0 (31.4–168.1) | 198.3 (132.2–247.5) | 78.3 (31.9–210.8) | 46.5 (15.5–59.5) | 0.003 |
D-dimer [< 1.0] | μg/mL | 36.4 (16.0–96.6) | 107.5 (74.4–136.2) | 40.0 (16.3–101.3) | 17.7 (7.7–28.2) | 0.002 |
TAT [< 3.0] | μg/L | 88.0 (30.1–200.0) | 198.5 (114.8–243.1) | 106.9 (56.6–200.0) | 60.8 (9.8–85.9) | 0.056 |
PIC [0.0–0.8] | μg/mL | 9.1 (2.8–17.8) | 18.2 (12.6–23.9) | 9.5 (3.1–18.0) | 4.9 (1.4–9.1) | 0.040 |
tPAI-1 [< 50] | ng/mL | 30 (3–602) | 89 (40–123) | 33 (19–80) | 30 (25–48) | 0.310 |
AT [80.0–120.0] | % | 96.2 (79.8–108.3) | 68.9 (63.8–85.2) | 92.2 (83.1–106.5) | 103.3 (97.1–110.0) | 0.023 |
PC [82.0–112.0] | % | 90.6 (75.8–101.5) | 66.0 (47.1–75.4) | 90.8 (78.0–102.8) | 97.1 (85.0–117.1) | 0.021 |
α2PI [80.0–130.0] | % | 90.5 (79.6–101.6) | 80.4 (72.9–95.9) | 84.6 (78.7–92.5) | 102.2 (95.6–107.2) | 0.003 |
PLG [80.0–130.0] | % | 93.8 (81.5–102.6) | 84.7 (70.6–85.6) | 92.5 (80.9–100.6) | 101.5 (93.8–107.1) | 0.071 |
sTM [1.8–4.1] | F/U | 2.9 (2.3–3.7) | 3.6 (2.7–3.6) | 3.1 (2.5–3.9) | 2.4 (2.3–3.0) | 0.099 |
IL-6* [< 4.0] | pg/mL | 108.5 (40.8–250.3) | 251.0 (191.8–326.8) | 119.0 (48.3–216.8) | 93.0 (27.8–98.8) | 0.037 |
Lactate [3.3–14.9] | mg/dL | 15.3 (10.8–21.6) | 14.5 (9.3–21.3) | 15.0 (11.0–17.0) | 17.0 (13.0–26.0) | 0.430 |
Alb [3.9–4.9] | g/dL | 3.9 (3.4–4.3) | 3.1 (2.9–3.3) | 3.8 (3.4–4.1) | 4.3 (4.2–4.6) | < 0.001 |
ADAMTS13 activity [70.0–120.0] | % | 63.6 (56.4–74.5) | 45.6 (42.1–47.7) | 61.2 (56.5–63.9) | 76.7 (75.5–82.5) | < 0.001 |
Transfusion Day 0 / Day 0–6 | ||||||
PRBC | Units | 0 (0–0) / 0 (0–2) | 0 (0–0) / 3 (2–6) | 0 (0–1) / 0 (0–4) | 0 (0–0) / 0 (0–0) | 0.990 / 0.104 |
FFP | Units | 0 (0–2) / 0 (0–2) | 2 (0–6) / 2 (0–10) | 0 (0–0) / 0 (0–0) | 0 (0–0) / 0 (0–0) | 0.430 / 0.412 |
Platelets | Units | 0 (0–0) / 0 (0–0) | 0 (0–0) / 0 (0–15) | 0 (0–0) / 0 (0–0) | 0 (0–0) / 0 (0–0) | 0.814 / 0.438 |
Intervention Day 0 / Day 0–6 | ||||||
IVR | n, (%) | 6 (15.3) / 6 (15.3) | 2 (33.3) / 2 (33.3) | 2 (10.0) / 2 (10.0) | 2 (15.4) / 2 (15.4) | 0.381 / 0.381 |
Craniotomy | n, (%) | 3 (7.6) / 3 (7.6) | 1 (16.7) / 1 (16.7) | 1 (5.0) / 1 (5.0) | 1 (7.7) / 1 (7.7) | 0.643 / 0.643 |
Laparotomy | n, (%) | 1 (2.5) / 1 (2.5) | 0 (0.0) / 0 (0.0) | 1 (5.0) / 1 (5.0) | 0 (0.0) / 0 (0.0) | 0.614 / 0.614 |
ORIF | n, (%) | 0 (0.0) / 14 (35.9) | 0 (0.0) / 3 (50.0) | 1 (5.0) / 6 (30.0) | 0 (0.0) / 5 (38.5) | 0.614 / 0.651 |
Outcome | ||||||
DVT (+) | n, (%) | 6 (15.4) | 1 (16.7) | 4 (20.0) | 1 (7.7) | 0.629 |
In-hospital mortality | n, (%) | 2 (5.1) | 0 (0.0) | 1 (5.0) | 1 (7.7) | 0.779 |
ADAMTS13 activity on day 0 and its changes during the study period (Table 1 and Fig. 1)
Correlation between ADAMTS13 activities and the coagulofibrinolysis related parameters on day 0 (Figs. 2 and 3 and Tables 1 and 2)
OR (95% CI) | P value | |
---|---|---|
Development of DVT | 1.120 (0.107, 11.726) | 0.925 |
Development of DIC | 7.429 (1.121, 49.244) | 0.038 |
Requirement of transfusion of FFP | 9.000 (1.327, 61.025) | 0.028 |