Background
Methods
Patient selection and data collection
Definitions
Statistical analysis
Results
Patient characteristics
TBI n = 111 | Non-TBI n = 126 |
P value | |
---|---|---|---|
Age, years | 64 (43–76) | 44 (30–64) | <0.001 |
Male, n (%) | 83 (75) | 82 (65) | 0.105 |
ISS | 25 (17–26) | 21 (17–27) | 0.044 |
Revised trauma score | 6.90 (5.97–7.84) | 7.84 (7.11–7.84) | <0.001 |
Heart rate, per min | 85 (74–93) | 89 (76–103) | 0.034 |
Systolic BP, mmHg | 152 (129–178) | 116 (96–138) | <0.001 |
Respiratory rate, per min | 19 (18–24) | 23 (18–28) | 0.001 |
Body temperature, °C | 36.2 (35.8–36.7) | 36.4 (35.8–36.8) | 0.334 |
Glasgow coma scale score | 12 (6–14) | 14 (13–15) | <0.001 |
Time from the accident to sample collection | |||
0–30 min, n (%) | 33 (30) | 29 (24) | 0.122 |
31–60 min, n (%) | 56 (51) | 64 (52) | |
61–90 min, n (%) | 7 (6) | 18 (15) | |
91–120 min, n (%) | 7 (6) | 2 (2) | |
Over 120 min, n (%) | 6 (6) | 10 (8) | |
Unknown, n (%) | 2 (2) | 3 (2) | |
Arterial blood gas analyses | |||
pH | 7.39 (7.35–7.42) | 7.38 (7.33–7.42) | 0.061 |
Base deficit, mmol/L | 1.2 (-0.4–3.0) | 1.8 (0.2–4.4) | 0.044 |
Lactate, mmol/L | 2.40 (1.40–3.20) | 2.65 (1.70–3.62) | 0.081 |
Laboratory parameters | |||
White blood cells, × 109/L | 9.9 (7.3–12.8) | 11.8 (9.2–16.0) | <0.001 |
Haemoglobin, g/dL | 13.7 (12.4–14.8) | 12.8 (11.3–14.4) | 0.009 |
Platelet count, × 109/L | 18.3 (14.7–23.5) | 22.9 (18.2–26.3) | <0.001 |
AST, U/L | 31 (25–44) | 76 (45–156) | <0.001 |
ALT, U/L | 25 (17–34) | 49 (29–100) | <0.001 |
LDH, U/L | 270 (217–327) | 469 (348–723) | <0.001 |
CK, U/L | 149 (99–246) | 317 (214–532) | <0.001 |
PT-INR | 1.01 (0.96–1.10) | 1.06 (0.99–1.13) | 0.009 |
APTT, sec | 25.0 (23.0–28.2) | 25.6 (23.5–29.0) | 0.306 |
Fibrinogen, mg/dL | 246 (181–296) | 229 (196–280) | 0.569 |
D-dimer, μg/mL | 22.4 (7.6–49.6) | 23.8 (8.1–58.6) | 0.500 |
TBI |
P value | Non-TBI |
P value | |||
---|---|---|---|---|---|---|
Hyperfibrinolysis (-)
n = 77 | Hyperfibrinolysis (+)
n = 34 | Hyperfibrinolysis (-)
n = 80 | Hyperfibrinolysis (+)
n = 46 | |||
Age, years | 61 (41–72) | 70 (51–83) | 0.028 | 45 (36–62) | 43 (26–70) | 0.895 |
Male, n (%) | 60 (78) | 23 (68) | 0.251 | 61 (76) | 25 (54) | 0.001 |
ISS | 17 (16–26) | 25 (25–26) | 0.011 | 20 (17–25) | 27 (18–34) | 0.003 |
Revised trauma score | 7.10 (6.17–7.84) | 5.50 (4.09–7.84) | <0.001 | 7.84 (7.55–7.84) | 7.55 (6.61–7.84) | 0.022 |
Heart rate, per min | 85 (75–93) | 84 (65–93) | 0.467 | 85 (71–98) | 96 (85–111) | 0.001 |
Systolic BP, mmHg | 144 (126–169) | 170 (138–193) | 0.004 | 122 (103–140) | 104 (87–128) | 0.016 |
Respiratory rate, per min | 19 (18–23) | 20 (16–25) | 0.774 | 22 (18–25) | 24 (20–30) | 0.036 |
Body temperature, °C | 36.2 (35.8–36.7) | 36.2 (35.6–36.8) | 0.708 | 36.5 (35.8–36.9) | 36.3 (35.7–36.6) | 0.210 |
Glasgow coma scale score | 13 (9–14) | 6 (3–13) | <0.001 | 14 (14–15) | 14 (12–15) | 0.017 |
Time from the accident to sample collection | ||||||
0–30 min, n (%) | 21 (28) | 12 (35) | 0.469 | 17 (22) | 12 (27) | 0.641 |
31–60 min, n (%) | 38 (51) | 18 (53) | 43 (54) | 21 (48) | ||
61–90 min, n (%) | 5 (7) | 2 (6) | 13 (17) | 5 (11) | ||
91–120 min, n (%) | 7 (9) | 0 (0) | 1 (1) | 1 (2) | ||
Over 120 min, n (%) | 4 (5) | 2 (6) | 5 (6) | 5 (11) | ||
Unknown, n (%) | 2 (3) | 0 (0) | 1 (1) | 2 (4) | ||
Arterial blood gas analyses | ||||||
pH | 7.39 (7.35–7.43) | 7.39 (7.37–7.42) | 0.824 | 7.38 (7.34–7.43) | 7.36 (7.30–7.40) | 0.922 |
Base deficit, mmol/L | 1.1 (-0.4–2.9) | 1.3 (-0.2–3.4) | 0.707 | 1.7 (0.1–3.9) | 2.4 (0.6–5.9) | 0.676 |
Lactate, mmol/L | 2.40 (1.40–3.20) | 2.44 (1.70–2.89) | 0.738 | 2.30 (1.50–3.26) | 2.90 (2.00–5.77) | 0.454 |
Laboratory parameters | ||||||
White blood cells, × 109/L | 8.7 (6.9–12.3) | 11.2 (8.9–13.5) | 0.013 | 11.1 (8.9–14.5) | 13.7 (10.2–17.9) | 0.009 |
Haemoglobin, g/dL | 14.0 (12.8–14.9) | 13.1 (11.8–14.3) | 0.075 | 13.9 (12.0–14.8) | 12.2 (10.9–13.1) | <0.001 |
Platelet count, × 109/L | 19.1 (15.6–24.1) | 17.0 (14.6–21.2) | 0.170 | 23.2 (18.7–26.6) | 20.2 (17.0–26.0) | 0.079 |
AST, U/L | 29 (24–37) | 40 (29-49) | 0.022 | 63 (33–143) | 109 (64–196) | 0.004 |
ALT, U/L | 24 (17–34) | 27 (17–34) | 0.813 | 44 (24–81) | 73 (40–116) | 0.011 |
LDH, U/L | 249 (208–301) | 312 (262–377) | 0.001 | 378 (275–518) | 677 (523–1064) | <0.001 |
CK, U/L | 144 (95–232) | 175 (115–300) | 0.183 | 289 (183–442) | 455 (258–749) | 0.001 |
PT-INR | 1.00 (0.96–1.05) | 1.10 (0.97–1.17) | 0.005 | 1.02 (0.96–1.07) | 1.12 (1.06–1.20) | <0.001 |
APTT, sec | 24.1 (22.5–26.2) | 29.8 (25.9-34.1) | <0.001 | 24.9 (23.1–27.1) | 28.1 (24.8–31.9) | <0.001 |
Fibrinogen, mg/dL | 260 (219–299) | 207 (149–269) | 0.004 | 248 (206–293) | 215 (177–264) | 0.014 |
D-dimer, μg/mL | 10.5 (5.8–23.5) | 93.2 (52.6–129.3) | <0.001 | 12.2 (5.8–23.0) | 65.0 (54.6–100.0) | <0.001 |
Haemostatic treatments and amounts of transfusion
TBI |
P value | Non-TBI |
P value | |||
---|---|---|---|---|---|---|
Hyperfibrinolysis (-) n = 77 | Hyperfibrinolysis (+) n = 34 | Hyperfibrinolysis (-) n = 80 | Hyperfibrinolysis (+) n = 46 | |||
Haemostatic intervention, n (%) | 1 (1) | 0 (0) | 0.504 | 28 (35) | 25 (54) | 0.034 |
Tranexamic acid administration, n (%) | 28 (36) | 14 (41) | 0.630 | 10 (13) | 16 (35) | 0.003 |
Transfusion in the first 6 h after admission | ||||||
RBC, units | 0 (0–0) | 0 (0–4) | <0.001 | 0 (0–0) | 4 (0–12) | <0.001 |
FFP, units | 0 (0–0) | 0 (0–6) | <0.001 | 0 (0–0) | 0 (0–10) | 0.001 |
PC, units | 0 (0–0) | 0 (0–0) | 0.168 | 0 (0–0) | 0 (0–0) | 0.06 |
≥ 10 units RCC, n (%) | 0 (0) | 5 (15) | 0.001 | 7 (9) | 15 (33) | 0.001 |
Transfusion in the first 24 h after admission | ||||||
RBC, units | 0 (0–0) | 0 (0–8) | <0.001 | 0 (0–0) | 6 (0–16) | <0.001 |
FFP, units | 0 (0–0) | 0 (0–6) | <0.001 | 0 (0–0) | 4 (5–12) | <0.001 |
PC, units | 0 (0–0) | 0 (0–0) | 0.137 | 0 (0–0) | 0 (0–0) | 0.05 |
≥ 10 units RCC, n (%) | 0 (0) | 8 (20) | <0.001 | 9 (11) | 16 (35) | 0 |
Mortality rates
TBI |
P value | Non-TBI |
P value | |||
---|---|---|---|---|---|---|
Hyperfibrinolysis (-) n = 77 | Hyperfibrinolysis (+) n = 34 | Hyperfibrinolysis (-) n = 80 | Hyperfibrinolysis (+) n = 46 | |||
Mortality, 24 h, n (%) | 1 (1) | 8 (24) | <0.001 | 2 (3) | 4 (9) | 0.12 |
Mortality, 48 h, n (%) | 3 (4) | 13 (38) | <0.001 | 2 (3) | 4 (9) | 0.12 |
Mortality, 28 d, n (%) | 4 (5) | 17 (50) | <0.001 | 2 (3) | 4 (9) | 0.12 |
In-hospital mortality, n (%) | 4 (5) | 17 (50) | <0.001 | 2 (3) | 4 (9) | 0.12 |
Factors associated with hyperfibrinolysis
Associations between coagulofibrinolytic variables and lactate level
TBI | Non-TBI | |||
---|---|---|---|---|
Pearson’s ρ |
P value | Pearson's ρ |
P value | |
PT-INR | 0.182 | 0.147 | 0.387 | <0.001 |
APTT | 0.054 | 0.622 | 0.309 | 0.001 |
Fibrinogen | - 0.076 | 0.525 | - 0.202 | 0.037 |
D-dimer | 0.014 | 0.902 | 0.220 | 0.016 |