Analysis of risk factors for trauma-induced coagulopathy in elderly major trauma patients

doi:10.5847/wjem.j.1920-8642.2024.093

Abstract

Abstract:

BACKGROUND: Trauma-induced coagulopathy (TIC) due to serious injuries significantly leads to increased mortality and morbidity among elderly patients. However, the risk factors of TIC are not well elucidated. This study aimed to explore the risk factors of TIC in elderly patients who have major trauma.

METHODS: In this retrospective study, the risk factors for TIC in elderly trauma patients at a single trauma center were investigated between January 2015 and September 2020. The demographic information including gender, age, trauma parts, injury severity, use of blood products, use of vasopressors, need of emergency surgery, duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and hospital, and clinical outcomes were extracted from electric medical records. Multivariate logistic regression analysis was performed to differentiate risk factors, and the performance of the model was evaluated using receiver operating characteristics (ROC) curves.

RESULTS: Among the 371 elderly trauma patients, 248 (66.8%) were male, with the age of 72.5 ± 6.8 years, median injury severity score (ISS) of 24 (IQR: 17-29), and Glasgow coma score (GCS) of 14 (IQR: 7-15). Of these patients, 129 (34.8%) were diagnosed with TIC, whereas 242 (65.2%) were diagnosed with non-TIC. The severity scores such as ISS (25 [20-34] vs. 21 [16-29], P<0.001) and shock index (SI), (0.90±0.66 vs. 0.58 ± 0.18, P<0.001) was significantly higher in the TIC group than in the non-TIC group. Serum calcium levels (1.97±0.19 mmol/L vs. 2.15±0.16 mmol/L, P<0.001), fibrinogen levels (1.7±0.8 g/L vs. 2.8±0.9 g/L, P<0.001), and base excess (BE, -4.9±4.6 mmol/L vs. -1.2 ± 3.1 mmol/L, P<0.001) were significantly lower in the TIC group than in the non-TIC group. Multivariate logistic regression analysis revealed that ISS>16 (OR: 3.404, 95%CI: 1.471-7.880; P=0.004), SI>1 (OR: 5.641, 95%CI: 1.700-18.719; P=0.005), low BE (OR: 0.868, 95%CI: 0.760-0.991; P=0.037), hypocalcemia (OR: 0.060, 95%CI: 0.009-0.392; P=0.003), and hypofibrinogenemia (OR: 0.266, 95%CI: 0.168-0.419; P<0.001) were independent risk factors for TIC in elderly trauma patients. The AUC of the prediction model included all these risk factors was 0.887 (95%CI: 0.851-0.923) with a sensitivity and specificity of 83.6% and 82.6%, respectively.

CONCLUSION: Higher ISS (more than 16), higher SI (more than 1), acidosis, hypocalcemia, and hypofibrinogenemia emerged as independent risk factors for TIC in elderly trauma patients.

Key words: Trauma, Elderly patients, Trauma-induced coagulopathy, Hypocalcemia

Yangbo Kang, Qi Yang, Hongbo Ding, Yufeng Hu, Jiasheng Shen, Feng Ruan, Bojin Chen, Yiping Feng, Yuchen Jin, Shanxiang Xu, Libing Jiang, Guirong Wang, Yong’an Xu. Analysis of risk factors for trauma-induced coagulopathy in elderly major trauma patients[J]. World Journal of Emergency Medicine, 2024, 15(6): 475-480.

Figures/Tables 5

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Table 1.

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Figure 2.

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Variables	Non-TIC (n=242)	TIC (n=129)	P- value
Age, years	72.5±7.0	72.6±6.3	0.853
Male, n (%)	160 (66.1)	88 (68.2)	0.682
Injured parts, n (%)
Head and neck	207 (85.5)	97 (75.2)	0.014
Face Thorax	32 (13.2) 128 (52.9)	18 (14) 82 (63.6)	0.844 0.048
Abdomen	30 (12.4)	34 (26.4)	0.001
Extremities	92 (38.0)	81 (62.8)	<0.001
Body surface	21 (8.7)	6 (4.7)	0.155
SBP, mmHg	150.4±29.1	122.3±39.3	<0.001
HR, beats/min	84.1±17.6	93.8±20.0	<0.001
Body temperature, ℃	37.4±0.8	37.1±0.8	0.005
ISS	21 (16-29)	25 (20-34)	<0.001
GCS	14 (8-15)	14 (6-15)	0.156
SI	0.58±0.18	0.90±0.66	<0.001
Blood gas analysis
Lactate, mmol/L	1.8 (1.3-2.9)	3.2 (2.1-4.9)	<0.001
BE, mmol/L	-1.2±3.1	-4.9±4.6	<0.001
pH	7.39±0.06	7.35±0.08	<0.001
Biochemical electrolyte
Ca²⁺, mmol/L	2.15±0.16	1.97±0.19	<0.001
K⁺, mmol/L	4.00±0.55	3.99±0.58	0.888
Na⁺, mmol/L	140.0±3.76	140.3±3.72	0.440
Coagulation parameters
INR	1.1±0.1	1.5±0.4	<0.001
Fibrinogen, g/L	2.8±0.9	1.7±0.8	<0.001
APTT, s	33.8±4.1	47.6±21.8	<0.001
PT, s	13.7±0.8	18.0±3.9	<0.001
Blood routine
Platelet, ×10⁹/L	163.7±54.2	139.4±53.4	<0.001
Hemoglobin, g/L	123.3±19.8	96.8±25.2	<0.001
Blood products, n (%) Vasopressors, n (%) Acute surgery, n (%)	7 (2.9) 53 (21.9) 6 (2.5)	12 (9.3) 61 (47.3) 20 (15.5)	0.008 <0.001 <0.001
In-hospital mortality, n (%)	33 (13.6)	36 (27.9)	<0.001
MV, n (%)	127 (52.5)	95 (73.6)	<0.001
Duration of MV, d	2.7±5.0	4.6±8.0	0.017
LOS in ICU, d	4.5±4.9	5.6±6.1	0.080
LOS in hospital, d	15.9±12.3	17.6±13.8	0.218

Variables	severe TIC (n=38)	Non-severe TIC (n=91)	P- value
Age, year	72.0±6.1	72.9±6.4	0.448
Male, n (%)	30 (78.9)	58 (63.7)	0.091
Injured parts, n (%)
Head and neck	24 (63.2)	73 (80.2)	0.041
Face Thorax	4 (10.5) 24 (63.2)	14 (15.4) 58 (63.7)	0.468 0.950
Abdomen	10 (26.3)	24 (26.4)	0.995
Extremities	29 (76.3)	52 (57.1)	0.040
Body surface	2 (5.3)	4 (4.4)	1.000
SBP, mmHg	102.8±31.9	130.4±39.4	<0.001
HR, beats/min	97.5±20.9	92.2±19.5	0.169
Body temperature, ℃	36.9±1.1	37.2±0.7	0.192
ISS	26 (17-30)	25 (20-34)	0.805
GCS	14 (3-15)	14 (7-15)	0.402
SI	1.18±1.08	0.78±0.30	0.030
Blood gas analysis
Lactate, mmol/L	5.1 (3.2-7.6)	2.9 (1.7-4.1)	<0.001
BE, mmol/L	-7.6±5.3	-3.8±3.8	<0.001
pH	7.31±0.09	7.37±0.06	0.001
Biochemical electrolyte
Ca²⁺, mmol/L	1.87±0.19	2.02±0.18	<0.001
K⁺, mmol/L	3.9±0.6	4.0±0.6	0.211
Na⁺, mmol/L	140.6±4.0	140.1±3.6	0.486
Coagulation parameters
INR	2.0±0.5	1.3±0.1	<0.001
Fibrinogen, g/L	1.1±0.6	2.0±0.7	<0.001
APTT, s	65.3±31.7	40.3±8.5	<0.001
PT, s	22.5±4.6	16.1±0.9	<0.001
Blood routine
Platelet, ×10⁹/L	115.3±40.8	149.5±55.0	0.001
Hemoglobin, g/L	86.9±30.0	100.9±21.9	0.004
Blood products, n (%) Vasopressors, n (%) Acute surgery, n (%)	4 (10.5) 27 (71.1) 12 (31.6)	8 (8.8) 34 (37.4) 8 (8.8)	1.000 <0.001 0.001
In-hospital mortality, n (%)	16 (42.1)	20 (22.0)	0.020
MV, n (%)	31 (81.6)	64 (70.3)	0.186
Duration of MV, d	5.1±7.1	4.4±8.4	0.653
LOS in ICU, d	6.3±6.7	5.2±5.9	0.370
LOS in hospital, d	15.2±13.9	18.7±13.7	0.192

Factors	OR (95% CI)	P-value
Body temperature	0.767 (0.516-1.139)	0.189
ISS > 16	3.404 (1.471-7.880)	0.004
SI > 1	5.641 (1.700-18.719)	0.005
Platelet	0.995 (0.989-1.001)	0.112
pH	26.602 (0.085-8,329.401)	0.263
Hypocalcemia	0.060 (0.009-0.392)	0.003
Lactate	1.037 (0.864-1.245)	0.694
BE	0.868 (0.760-0.991)	0.037
Fibrinogen	0.266 (0.168-0.419)	<0.001