Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury
Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury
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DOI：
10.1089/neu.2015.4039
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发表时间：
2016-04-01
影响因子：
4.2
通讯作者：
Yokota, Hiroyuki
中科院分区：
文献类型：
--
作者：
Nakae, Ryuta;Takayama, Yasuhiro;Yokota, Hiroyuki
长期以来，创伤性脑损伤 (TBI) 一直与凝血功能障碍相关。然而，TBI 急性期凝血/纤溶参数的时间进程仍不清楚。本研究的目的是分析 TBI 急性期凝血/纤溶参数的时程，并阐明参数与预后的关系。我们回顾性评估了 234 名患有严重孤立性 TBI 的患者，其初始血样在受伤后 1 小时内采集。在到达急诊科时以及受伤后 3、6 和 12 小时测量血小板计数、凝血酶原时间、活化部分凝血活酶时间 (aPTT)、血浆纤维蛋白原和 D-二聚体水平。进行多变量逻辑回归分析，以确定每个时间点预后不良的危险因素。从入院到受伤后 12 小时，D-二聚体水平升高是一个显着的负面预后指标（入院：p < 0.0001；受伤后 3 小时：p = 0.0005；受伤后 6 小时：p = 0.005；受伤后 12 小时：p = 0.0009）。入院时和受伤后 3 小时 aPTT 的上升趋势也是一个显着的负面预后指标（入院：p = 0.0011；受伤后 3 小时：p = 0.013）。在包括所有初始变量的多变量逻辑回归分析中，预后不良的独立危险因素包括年龄较大（p = 0.0005）、格拉斯哥昏迷量表评分低（p < 0.0001）、简明损伤评分高（p = 0.015）、aPTT > 30.2 秒（p = 0.019）和 D-二聚体水平升高（p = 0.0005）。我们得出的结论是，D-二聚体是监测预测结果的最佳凝血/纤溶参数。
Traumatic brain injury (TBI) has long been associated with coagulopathy; however, the time course of coagulation/fibrinolytic parameters in the acute phase of TBI remains unclear. The purpose of the study was to analyze the time course of coagulation/fibrinolytic parameters in the acute phase of TBI and to elucidate parameter relationships to prognosis. We retrospectively evaluated 234 patients with severe isolated TBI with initial blood samples obtained no more than 1 h after injury. Platelet count, prothrombin time, activated partial thromboplastin time (aPTT), plasma levels of fibrinogen, and D-dimer were measured on arrival in the emergency department and 3, 6, and 12 h after injury. Multivariate logistic regression analysis was performed to identify risk factors for poor prognosis at each time point. From hospital admission to 12 h after injury, an elevated D-dimer level was a significant negative prognostic indicator (admission: p < 0.0001; 3 h after injury: p = 0.0005; 6 h after injury: p = 0.005; 12 h after injury: p = 0.0009). An upward trend of aPTT on admission and 3 h after injury was also a significant negative prognostic indicator (admission: p = 0.0011; 3 h after injury: p = 0.013). On multivariate logistic regression analysis, which included all initial variables, independent risk factors for poor prognosis included older age (p = 0.0005), low Glasgow Coma Scale score (p < 0.0001), high Abbreviated Injury Score (p = 0.015), aPTT >30.2 sec (p = 0.019), and elevated D-dimer level (p = 0.0005). We concluded that D-dimer is the best coagulation/fibrinolytic parameter to monitor for prediction of outcome.