Background
Methods
Study Design
Patient selection
ISS > 26 | ISS 15-26 | ISS < 15 | p-value | |||
---|---|---|---|---|---|---|
Demography, injury severity, transfusion and mortality
| ||||||
N | 23 | 26 | 30 | |||
Age | yrs | 45 (25-71) | 57 (43-65) | 42 (28-49) |
0.034
|
c
|
Gender | m% (n) | 74% (17) | 62% (16) | 67% (20) | NS | |
Blunt trauma | % (n) | 96% (22) | 96% (25) | 83% (25) | 0.142 | |
ISS | score | 34 (29-36) | 22 (17-25) | 9 (5-10) | NA | |
sTBI | % (n) | 17% (4) | 46% (12) | 29% (6) | 0.091 | |
GCS (PH) | score | 7 (3-13) | 11 (6-15) | 15 (12-15) |
0.002
|
a
|
Crystalloids (PH) | ml | 900 (250-1250) | 275 (0-500) | 250 (25-750) |
0.013
|
a, b
|
RBC 0-24 h | units | 2 (0-12) | 1 (0-3) | 0 (0-1) |
0.007
|
a
|
FFP 0-24 h | units | 2 (0-9) | 0 (0-1) | 0 (0-0) |
0.003
|
a
|
PLT 0-24 h | units | 0 (0-4) | 0 (0-0) | 0 (0-0) |
0.006
|
a
|
MT (> 10 RBC in 24 h) | % (n) | 35% (8) | 4% (1) | 3% (1) |
0.001
|
a, b
|
Mortality | % (n) | 39% (9) | 15% (4) | 3% (1) |
0.003
|
a
|
Shock, sympathoadrenal activation, cell damage, biochemistry and hemostasis
| ||||||
SBP (PH) | mmHg | 150 (108-156) | 136 (125-152) | 130 (123-143) | NS | |
pH | 7.31 (7.25-7.33) | 7.40 (7.307.40) | 7.37 (7.33-7.41) |
0.001
|
a, b
| |
Lactate | mmol/l | 1.7 (1.2-2.2) | 2.5 (1.3-3.1) | 1.5 (0.9-2.1) |
0.049
|
c
|
SBE | mmol/l | -3.6 (-5.7- -1.9) | -2.7 (-4.6- -0.5) | -1.0 (-1.8-0.7) |
0.005
|
a
|
Adrenaline | pg/ml | 1,062 (328-1,549) | 292 (126-1,077) | 247 (86-354) |
0.002
|
a
|
Noradrenaline | pg/ml | 1,235 (434-1,511) | 652 (210-1,288) | 332 (217-1,036) |
0.040
|
a
|
hcDNA | % | 16.9 (5.6-27.0) | 5.6 (2.4-10.3) | 0.4 (0.0-9.3) |
<0.001
|
a
|
Hemoglobin | mmol/l | 8.0 (6.3-9.2) | 8.6 (7.2-9.1) | 8.4 (7.7-8.9) | NS | |
Platelet count | 109/l | 217 (165-252) | 193 (173-260) | 211 (191-240) | NS | |
Fibrinogen | g/l | 2.0 (1.4-2.2) | 2.4 (2.1-2.9) | 2.6 (2.3-2.9) |
0.002
|
a, b
|
FXIII | microg/ml | 25 (20-30) | 30 (22-40) | 32 (28-41) |
0.001
|
a
|
vWF | % | 190 (110-218) | 200 (132-223) | 204 (146-230) | NS | |
APTT > 35 sec | % | 22% (5) | 4% (1) | 0% |
0.009
|
a
|
INR > 1.2 | % | 43% (10) | 0% | 0% |
<0.001
|
a, b
|
Thrombelastography
| ||||||
R | min | 5.1 (4.8-5.9) | 5.9 (5.1-6.7) | 6.0 (5.3-6.4) |
0.046
| |
Angle | degrees | 65 (62-68) | 67 (62-7) | 66 (62-70) | NS | |
MA | mm | 63 (58-67) | 64 (62-68) | 63 (61-67) | NS | |
Ly30 | % | 0.2 (0.0-0.7) | 0.0 (0.0-0.2) | 0.3 (0.0-1.0) |
0.040
| |
Platelet activation and thrombin generation
| ||||||
sCD40L | pg/ml | 394 (281-551) | 327 (251-406) | 250 (195-305) |
0.006
|
a
|
PF1.2 | nmol/l | 4.1 (1.1-13.0) | 15.1 (4.1-45.3) | 4.2 (1.6-9.5) |
0.026
|
b, c
|
TAT | ng/ml | 36 (32-41) | 39 (33-44) | 35 (29-40) | 0.181 | |
Natural anticoagulation
| ||||||
AT | 103 U/l | 0.89 (0.69-0.96) | 0.9 (0.8-1.00) | 0.98 (0.90-1.07) |
0.002
|
a
|
PC | % | 92 (75-116) | 107 (96-123) | 117 (100-129) |
0.031
|
a
|
APC | ng/ml | 10.4 (9.4-12.1) | 10.5 (8.7-13.5) | 8.0 (6.8-10.5) |
0.005
|
a, c
|
TFPI | ng/ml | 64 (48-86) | 67 (52-80) | 54 (41-74) | NS | |
Fibrinolysis
| ||||||
D-dimer | ng/ml | 173 (172-176) | 170 (144-175) | 128 (36-148) |
<0.001
|
a, c
|
tPA | ng/ml | 7.3 (5.5-15.4) | 7.8 (4.7-13.7) | 5.2 (2.0-9.9) | 0.063 | |
PAI-1 | ng/ml | 24 (11-37) | 31 (14-68) | 20 (13-27) | 0.145 | |
PAP | ng/ml | 316 (22-599) | 475 (83-1152) | 225 (54-393) | 0.159 |
Blood sampling
Enzyme linked immunosorbent assay (ELISA) measurements
Thrombelastography (TEG)
Statistics
Results
Study patients
Injury severity and coagulopathy
Maximum clot strength and biomarkers of coagulopathy
Normal | Hyper- coagulable | Hypo- coagulable | Hyper- fibrinolysis | p-valuea | ||
---|---|---|---|---|---|---|
(51-69 mm) | (> 69 mm) | (< 51 mm) | (< 51 mm/> 8%) | |||
Demography, injury severity, transfusion and mortality
| ||||||
N | 69 | 9 | 1 | 1 | ||
Age | yrs | 44 (32-58) | 72 (59-80) | 63 | 80 |
0.006
|
Gender | m% (n) | 68% (47) | 56% (5) | 100% | 100% | NS |
Blunt trauma | % (n) | 90% (62) | 100% | 100% | 100% | NS |
ISS | score | 18 (10-29) | 17 (16-20) | 25 | 50 | NS |
sTBI | % (n) | 30% (18) | 33% (3) | 100% | 0% | NS |
GCS (PH) | score | 13 (6-15) | 12 (9-14) | 7 | 6 | NS |
Crystalloids (PH) | ml | 300 (0-1000) | 500 (200-500) | 0 | 500 | NS |
RBC 0-24 h | units | 0 (0-4) | 0 (0-1) | 0 | 45 | NS |
FFP 0-24 h | units | 0 (0-3) | 0 (0-0) | 0 | 36 | NS |
PLT 0-24 h | units | 0 (0-1) | 0 (0-0) | 0 | 15 | NS |
MT (> 10 RBC in 24 h) | % (n) | 14% (10) | 0% | 0% | 100% | 0.159 |
Mortality | % (n) | 16% (11) | 22% (2) | 0% | 100% | NS |
Shock, sympathoadrenal activation, cell damage, biochemistry and hemostasis
| ||||||
SBP (PH) | mmHg | 135 (122-149) | 129 (100-153) | 170 | 95 | NS |
pH | 7.34 (7.29-7.38) | 7.37 (7.31-7.41) | 7.38 | 7.06 | NS | |
Lactate | mmol/l | 1.9 (1.4-2.9) | 2.3 (1.4-2.8) | 1.3 | 8.4 | NS |
SBE | mmol/l | -2.1 (-4.1--0.2) | 0.3 (-2.0-0.7) | -1.9 | -10.7 | 0.127 |
Adrenaline | pg/ml | 295 (112-976) | 1,163 (191-1,471) | 298 | 5,427 | 0.169 |
Noradrenaline | pg/ml | 638 (276-1,307) | 1,146 (120-2,540) | 731 | 549 | NS |
HcDNA | % | 4.7 (0.1-13.5) | 10.0 (7.2-16.4) | 9.8 | 17.1 | 0.126 |
Hemoblobin | mmol/l | 8.4 (7.6-9.1) | 7.5 (6.5-8.8) | 8.8 | 6.4 | NS |
Platelet count | 109/l | 206 (173-251) | 275 (185-306) | 117 | 172 |
0.045
|
Fibrinogen | g/l | 2.3 (2.0-2.7) | 3.1 (3.0-3.4) | 1.1 | 1.1 |
< 0.001
|
FXIII | microg/ml | 29 (24-36) | 37 (29-43) | 21 | 18 | 0.096 |
vWF | % | 200 (127-225) | 190 (151-222) | 124 | 203 | NS |
APTT > 35 sec | % (n) | 7% (5) | 0% | 0% | 100% | NS |
INR > 1.2 | % (n) | 13% (9) | 0% | 0% | 100% | 0.134 |
Thrombelastography
| ||||||
R | min | 5.6 (4.9-6.4) | 5.4 (5.1-5.7) | 6.7 | 6.1 | NS |
Angle | degrees | 65 (62-69) | 70 (67-73) | 41 | 54 |
0.027
|
MA | mm | 63 (61-66) | 71 (69-73) | 49 | 33 | NA |
Ly30 | % | 0.2 (0.0-0.6) | 0.0 (0.0-0.0) | 0 | 78 | 0.076 |
Platelet activation and thrombin generation
| ||||||
sCD40L | pg/ml | 292 (223-417) | 332 (263-406) | 399 | 1,431 | NS |
PF1.2 | nmol/l | 6.6 (2.7-18.0) | 4.5 (1.0-22.4) | 1.0 | 0.4 | NS |
TAT | ng/ml | 37 (31-43) | 36 (31-44) | 29 | 38 | NS |
Natural anticoagulation
| ||||||
AT | 103 U/l | 0.92 (0.82-1.02) | 0.95 (0.88-0.98) | 0.98 | 0.61 | NS |
PC | % | 108 (91-124) | 108 (100-135) | 138 | 71 | NS |
APC | ng/ml | 9.8 (7.6-12.1) | 9.3 (9.1-11.1) | 13.7 | 10.3 | NS |
TFPI | ng/ml | 58 (44-78) | 78 (57-84) | 126 | 68 | 0.075 |
Fibrinolysis
| ||||||
D-dimer | ng/ml | 166 (122-173) | 170 (141-174) | 179 | 173 | NS |
tPA | ng/ml | 6.9 (3.6-12.0) | 12.1 (5.8-14.8) | 2.6 | 25.4 | 0.123 |
PAI-1 | ng/ml | 22 (12-38) | 33 (24-68) | 8 | 24 | NS |
PAP | ng/ml | 283 (45-619) | 510 (331-1154) | 0 | 316 | 0.126 |
Injury severity and predictors of maximum clot strength
Univariate | Multivariate (model 1) | Multivariate (model 2) | |||||
---|---|---|---|---|---|---|---|
Unit | β (SE) | p | β (SE) | p | β (SE) | p | |
ISS > 26 (n = 23)
|
R
2
= 0.47
|
R
2
= 0.76
| |||||
Fibrinogen | 1 g/l | 6.59 (1.85) |
0.002
| 5.61 (1.86) |
0.007
| 4.65 (1.31) |
0.002
|
Platelets | 10 *109/l | 0.48 (0.28) | 0.094 | 0.29 (0.25) | 0.438 | 0.42 (0.18) |
0.032
|
FXIII | 1% | 0.43 (0.20) |
0.043
| 0.24 (0.19) | 0.212 | 0.17 (0.13) | 0.210 |
sCD40L | 100 pg/ml | -1.62 (0.53) |
0.006
| - | - | -1.62 (0.35) |
< 0.001
|
ISS 15-26 (n = 26)
|
R
2
= 0.75
|
R
2
= 0.76
| |||||
Fibrinogen | 1 g/l | 6.84 (1.08) |
< 0.001
| 6.33 (0.96) |
< 0.001
| 5.84 (1.04) |
< 0.001
|
Platelets | 10 *109/l | 0.41 (0.20) |
0.047
| 0.37 (0.13) |
0.011
| 0.44 (0.14) |
0.006
|
FXIII | 1% | 0.13 (0.11) | 0.245 | 0.01 (0.07) | 0.847 | 0.03 (0.07) | 0.712 |
sCD40L | 100 pg/ml | -0.95 (0.89) | 0.300 | - | - | -0.73 (0.61) | 0.250 |
ISS < 15 (n = 30)
|
R
2
= 0.41
|
R
2
= 0.41
| |||||
Fibrinogen | 1 g/l | 3.55 (1.12) |
0.004
| 3.26 (1.05) |
0.005
| 3.29 (1.07) |
0.005
|
Platelets | 10 *109/l | 0.34 (0.13) |
0.017
| 0.30 (1.05) |
0.019
| 0.28 (0.13) |
0.038
|
FXIII | 1% | 0.00 (0.04) | 0.986 | 0.00 (0.03) | 0.995 | -0.00 (0.03) | 0.984 |
sCD40L | 100 pg/ml | 0.38 (0.44) | 0.403 | - | - | 0.15 (0.38) | 0.691 |