Prevalence and impact of abnormal ROTEM(R) assays in severe blunt trauma: results of the 'Diagnosis and Treatment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study'.
Prevalence and impact of abnormal ROTEM(R) assays in severe blunt trauma: results of the 'Diagnosis and Treatment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study'.
复制标题
严重钝性创伤中异常 ROTEM(R) 检测的患病率和影响：“创伤诱发凝血病的诊断和治疗 (DIA-TRE-TIC) 研究”的结果。
DOI：
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发表时间：
2011
影响因子：
9.8
通讯作者：
M. Mittermayr
中科院分区：
文献类型：
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作者：
H. Tauber;Petra Innerhofer;Robert Breitkopf;Isabella Westermann;R. Beer;R. E. Attal;Alexander Strasak;M. Mittermayr
背景
ROTEM（®）/TEG（®）（旋转血栓弹性测定法）测定似乎可用于治疗出血性创伤患者。然而，关于异常ROTEM（®）检测的流行率和影响的数据很少。
方法
这是一项前瞻性队列研究，研究对象为2005年7月至2008年7月期间入住因斯布鲁克医科大学医院的钝性创伤患者（损伤严重度评分≥15或格拉斯哥昏迷评分≤14）。入院后测量标准凝血试验、抗凝血酶（AT）、凝血酶原片段（F1+2）、凝血酶-抗凝血酶复合物（达特）和ROTEM（®）测定。334例患者的数据仍用于最终分析。
结果
ROTEM（®）参数与标准凝血试验相关（所有斯皮尔曼r>0.5），并且对于定义的ROTEM（®）阈值检测到死亡率的显著差异[FIBTEM 7 mm（21% vs 9%，P=0.006），EXTEM MCF（最大凝块硬度）45 mm（25.4% vs 9.4%，P=0.001）]。EXTEM MCF与早期死亡率独立相关[比值比（OR）0.94，95%置信区间（CI）0.9-0.99]，MCF FIBTEM与红细胞输注需求独立相关（OR 0.92，95% CI 0.87-0.98）。在有或无头部损伤的多发伤患者（n=274）中，低纤维蛋白原浓度、纤维蛋白聚合受损和血凝块硬度降低的患病率分别为26%、30%和22%，因此高于长期国际标准化比率（14%）。纤维蛋白溶解亢进增加了病死率，并且在孤立性脑损伤（n=60）和多发性创伤（n=274）中的发生频率相同（5%，95% CI 1.04-13.92 vs 7.3%，95% CI 4.52-11.05）。所有患者均显示F1+2和达特升高，AT水平降低，表明凝血酶形成增加。
结论
我们的数据扩大了ROTEM（®）测定在创伤患者中有用的证据。治疗理念应侧重于维持纤维蛋白聚合和治疗纤溶亢进。
BACKGROUND
ROTEM(®)/TEG(®) (rotational thromboelastometry) assays appear to be useful for the treatment of bleeding trauma patients. However, data on the prevalence and impact of abnormal ROTEM(®) assays are scarce.
METHODS
This is a prospective cohort study of blunt trauma patients (Injury Severity Score ≥15 or Glasgow Coma Score ≤14) admitted to Innsbruck Medical University Hospital between July 2005 and July 2008. Standard coagulation tests, antithrombin (AT), prothrombin fragments (F1+2), thrombin-antithrombin complex (TAT), and ROTEM(®) assays were measured after admission. Data on 334 patients remained for final analysis.
RESULTS
ROTEM(®) parameters correlated with standard coagulation tests (all Spearman r>0.5), and significant differences in mortality were detected for defined ROTEM(®) thresholds [FIBTEM 7 mm (21% vs 9%, P=0.006), EXTEM MCF (maximum clot firmness) 45 mm (25.4% vs 9.4%, P=0.001)]. EXTEM MCF was independently associated with early mortality [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.9-0.99] and MCF FIBTEM with need for red blood cell transfusion (OR 0.92, 95% CI 0.87-0.98). In polytrauma patients with or without head injury (n=274), the prevalence of low fibrinogen concentrations, impaired fibrin polymerization, and reduced clot firmness was 26%, 30%, and 22%, respectively, and thus higher than the prolonged international normalized ratio (14%). Hyperfibrinolysis increased fatality rates and occurred as frequently in isolated brain injury (n=60) as in polytrauma (n=274) (5%, 95% CI 1.04-13.92 vs 7.3%, 95% CI 4.52-11.05). All patients showed elevated F1+2 and TAT and low AT levels, indicating increased thrombin formation.
CONCLUSIONS
Our data enlarge the body of evidence showing that ROTEM(®) assays are useful in trauma patients. Treatment concepts should focus on maintaining fibrin polymerization and treating hyperfibrinolysis.