Increased Plasma Hyaluronan Levels are Associated With Acute Traumatic Coagulopathy.
Increased Plasma Hyaluronan Levels are Associated With Acute Traumatic Coagulopathy.
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DOI：
10.1097/shk.0000000000001867
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发表时间：
2022-01-01
期刊：
影响因子：
--
通讯作者：
Richter JR
中科院分区：
文献类型：
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作者：
Walker SC;Richter RP;Zheng L;Ashtekar AR;Jansen JO;Kerby JD;Richter JR
急性创伤性凝血病（ATC）是一种内源性止血障碍，常导致创伤后早期死亡。内皮糖萼损伤与创伤诱导的凝血异常相关;然而，尚未评价透明质酸（HA）（糖萼的关键成分）与ATC之间的具体关系。我们对从最近一项研究中前瞻性收集的数据进行了二次分析，该研究纳入了我们的一级创伤中心收治的ABC评分≥2的创伤患者（>18岁）。抵达时记录部分凝血活酶时间（PTT）、国际标准化比率（INR）和血栓弹性描记术（TEG）参数。获得损伤特征和临床结局。在健康对照（HC）和创伤受试者中在到达时（t = 0 h）和12、24和48 h测量血浆HA水平。ATC定义为入院时INR>1.2或PTT≥36.5秒。评估HA水平的比较，并在0 h和24 h HA水平、凝血指标和临床结局之间进行斯皮尔曼相关性分析。P值<0.05被认为是显著的。48例创伤患者和22例对照者入组研究。16名创伤受试者入院时有凝血功能障碍。ATC受试者的HA水平在所有时间点均高于非凝血病受试者，并在24和48 h升高至高于HC水平。到达时，HA水平与TEG R-时间、PTT和INR相关。24小时的HA水平与输血需求增加、重症监护室和住院时间延长相关。脱落HA与创伤患者的早期凝血异常相关，这可能导致更差的结局。这些发现强调了需要更多的研究来评估HA在ATC中的机制作用。
Acute traumatic coagulopathy (ATC) is an endogenous impairment in hemostasis that often contributes to early mortality after trauma. Endothelial glycocalyx damage is associated with trauma-induced coagulation abnormalities; however, the specific relationship between hyaluronan (HA), a key glycocalyx constituent, and ATC has not been evaluated. We performed a secondary analysis of prospectively collected data from a recent study in which trauma patients (>18 years) admitted to our Level I trauma center with an ABC Score≥2 were enrolled. Partial thromboplastin time (PTT), international normalized ratio (INR) and thromboelastography (TEG) parameters were recorded at arrival. Injury characteristics and clinical outcomes were obtained. Plasma HA levels were measured in healthy controls (HC) and in trauma subjects at arrival (t = 0h) and 12, 24, and 48h. ATC was defined as admission INR>1.2 or PTT≥36.5 sec. Comparisons of HA levels were assessed, and Spearman’s correlations were performed between 0h and 24h HA levels, coagulation measures and clinical outcomes. P-values <0.05 were considered significant. Forty-eight trauma patients and 22 controls were enrolled for study. Sixteen trauma subjects were coagulopathic at admission. HA levels in subjects with ATC were higher than non-coagulopathic subjects at all time points and elevated above HC levels at 24 and 48h. At arrival, HA levels correlated with TEG R-time, PTT, and INR. HA levels at 24h correlated with increased transfusion requirements and intensive care unit and hospital lengths of stay. Shed HA is associated with early coagulation abnormalities in trauma patients, which may contribute to worse outcomes. These findings highlight the need for additional studies to evaluate the mechanistic role of HA in ATC.