Early coagulopathy predicts mortality in trauma
Early coagulopathy predicts mortality in trauma
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DOI：
10.1097/01.ta.0000075338.21177.ef
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发表时间：
2003-07-01
影响因子：
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通讯作者：
Murtha, M
中科院分区：
文献类型：
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作者：
MacLeod, JBA;Lynn, M;Murtha, M
背景。凝血功能障碍和出血是已知的创伤死亡原因；然而，凝血酶原时间（PT）和部分凝血活酶时间（PTT）与死亡率的实际关系尚不清楚。我们的目的是测量初始凝血功能障碍对创伤相关死亡率的预测价值。我们前瞻性地回顾了在一级创伤中心就诊的创伤患者的数据。对PT、PTT、血小板计数和混杂因素进行logistic回归分析，以确定凝血功能障碍是否为全因死亡率的预测因子。从创伤登记队列的20,103例患者中，14,397例具有完整的初始分析处置数据，7,638例具有最终分析所有变量的完整数据。总队列中76.2%为男性，平均年龄38岁（范围1-108岁），中位损伤严重程度评分为9。共有1,276例死亡（全因死亡率，8.9%）。损伤后早期凝血功能障碍的患病率很高，28%的患者在到达创伤室时出现异常PT（10,790例中有2,994例），8%的患者出现异常PTT（10,453例中有826例）。在具有性格数据和正常PT的患者中，7796例中有489例死亡，而PT异常的2994例中有579例死亡（6.3% vs. 19.3%; chi(2) = 414.1,p < 0.001）。单因素分析显示，PT异常死亡的比值比为3.6(95%可信区间[CI]， 3.15-4.08; p < 0.0001)， PTT异常死亡的比值比为7.81 （95% CI, 6.65-9.17; p < 0.001）。在多元回归模型中，PT和PTT仍然是死亡率的独立预测因子，而血小板计数则不是。该模型还包括独立危险因素年龄、损伤严重程度评分、现场和创伤后血压、血细胞比容、基底缺陷和头部损伤。该模型产生的校正优势比为PT的1.35 （95% CI, 1.11 - 1.68, p < 0.001）和PTT的4.26 （95% CI, 3.23-5.63, p < 0.001）。创伤后早期凝血异常的发生率很高，即使在存在其他危险因素的情况下，凝血异常也是死亡率的独立预测因素。初始PTT异常使调整后的死亡几率增加35%，初始PTT异常使调整后的死亡几率增加326%。
Background. Coagulopathy and hemorrhage are known contributors to trauma mortality; however, the actual relationship of prothrombin time (PT) and partial thromboplastin time (PTT) to mortality is unknown. Our objective was to measure the predictive value of the initial coagulopathy profile for trauma-related mortality.Methods. We reviewed prospectively collected data on trauma patients presenting to a Level I trauma center. A logistic regression analysis was performed of PT, PTT, platelet count, and confounders to determine whether coagulopathy is a predictor of all-cause mortality.Results. From a trauma registry cohort of 20,103 patients, 14,397 had complete disposition data for initial analysis and 7,638 had complete data for all variables in the final analysis. The total cohort was 76.2% male, the mean age was 38 years (range, 1-108 years), and the median Injury Severity Score was 9. There were 1,276 deaths (all-cause mortality, 8.9%). The prevalence of coagulopathy early in the postinjury period was substantial, with 28% of patients having an abnormal PT (2,994 of 10,790) and 8% of patients having an abnormal PTT (826 of 10,453) on arrival at the trauma bay. In patients with disposition data and a normal PT, 489 of 7,796 died, as compared with 579 of 2,994 with an abnormal PT (6.3% vs. 19.3%; chi(2) = 414.1,p < 0.001). Univariate analysis generated an odds ratio of 3.6 (95% confidence interval [CI], 3.15-4.08; p < 0.0001) for death with abnormal PT and 7.81 (95 % CI, 6.65-9.17; p < 0.001) for deaths with an abnormal PTT. The PT and PTT remained independent predictors of mortality in a multiple regression model, whereas platelet count did not. The model also included the independent risk factors age, Injury Severity Score, scene and trauma-bay blood pressure, hematocrit, base deficit, and head injury. The model generated an adjusted odds ratio of 1.35 for PT (95% CI, 1.11 - 1.68; p < 0.001) and 4.26 for PTT (95% CI, 3.23-5.63; p < 0.001).Conclusion:. The incidence of coagulation abnormalities, early after trauma, is high and they are independent predictors of mortality even in the presence of other risk factors. An initial abnormal PT increases the adjusted odds of dying by 35% and an initial abnormal PTT increases the adjusted odds of dying by 326%.