Time course of coagulation and fibrinolytic parameters in pediatric traumatic brain injury
Time course of coagulation and fibrinolytic parameters in pediatric traumatic brain injury
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DOI：
10.3171/2021.5.peds21125
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发表时间：
2021-11-01
影响因子：
1.9
通讯作者：
Yokobori, Shoji
中科院分区：
文献类型：
--
作者：
Nakae, Ryuta;Fujiki, Yu;Yokobori, Shoji
目的凝血功能障碍是创伤性脑损伤患者预后不良的危险因素。儿童和成人脑外伤患者凝血和纤溶指标的时程差异尚未明确。方法回顾分析脑外伤患者入院时、伤后3、6和12小时的凝血酶原时间(PT)-国际标准化比率(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原浓度和血浆D-二聚体水平。对儿童患者(年龄16岁)和成人患者(年龄16岁)之间的基线特征进行倾向性得分匹配分析。结果共纳入468例患者(46名儿童和422名成人)。倾向分数匹配产生了46对匹配的队列。儿童组伤后1~12h的PT-INR、APTT明显高于成年组，而纤维蛋白原浓度在伤后1~6h较低。两组伤后1~12小时血浆D-二聚体水平均升高，但组间差异无统计学意义。儿童组凝血和纤溶参数的多因素Logistic回归分析显示，凝血参数值无预后意义，但纤溶参数D-二聚体升高是一个独立的负面预后因素。结论与成人患者相比，儿童颅脑损伤急性期PT-INR和APTT延长，纤维蛋白原浓度降低，但与预后无关。根据格拉斯哥预后评分，D-二聚体是儿童脑外伤患者的独立预后因素。
OBJECTIVE Coagulopathy is a well-recognized risk factor for poor outcomes in patients with traumatic brain injury (TBI). Differences in the time courses of coagulation and fibrinolytic parameters between pediatric and adult patients with TBI have not been defined.METHODS Patients with TBI and an Abbreviated Injury Scale of the head score >= 3, in whom the prothrombin time (PT)-international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen concentration, and plasma D-dimer levels were measured on arrival and at 3, 6, and 12 hours after injury, were retrospectively analyzed. Propensity score-matched analyses were performed to adjust baseline characteristics between pediatric patients (aged < 16 years) and adult patients (aged >= 16 years).RESULTS A total of 468 patients (46 children and 422 adults) were included. Propensity score matching resulted in a matched cohort of 46 pairs. Higher PT-INR and APTT values at 1 to 12 hours after injury and lower fibrinogen concentrations at 1 to 6 hours after injury were observed in the pediatric group compared with the adult group. Plasma levels of D-dimer were elevated in both groups at 1 to 12 hours after injury, but no significant differences were seen between the groups. Multivariate logistic regression analysis of the initial coagulation and fibrinolytic parameters in the pediatric group revealed no prognostic significance of the coagulation parameter values, but elevation of the fibrinolytic parameter D-dimer was an independent negative prognostic factor.CONCLUSIONS In the acute phase of TBI, pediatric patients were characterized by prolongation of PT-INR and APTT and lower fibrinogen concentrations compared with adult patients, but these did not correlate with outcome. D-dimer was an independent prognostic outcome factor in terms of the Glasgow Outcome Scale in pediatric patients with TBI.