MacLeod Jana B A, Lynn Mauricio, McKenney Mark G, Cohn Stephen M, Murtha Mary
Jackson Memorial Hospital and Department of Surgery, University of Miami school of Medicine, Miami, Florida 33101, USA.
J Trauma. 2003 Jul;55(1):39-44. doi: 10.1097/01.TA.0000075338.21177.EF.
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.
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.
From a trauma registry cohort of 20103 patients, 14397 had complete disposition data for initial analysis and 7638 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 1276 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 (2994 of 10790) and 8% of patients having an abnormal PTT (826 of 10453) on arrival at the trauma bay. In patients with disposition data and a normal PT, 489 of 7796 died, as compared with 579 of 2994 with an abnormal PT (6.3% vs. 19.3%; chi2 = 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).
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%.
凝血功能障碍和出血是创伤死亡率的已知影响因素；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指标对创伤相关死亡率的预测价值。
我们回顾了前瞻性收集的在一级创伤中心就诊的创伤患者的数据。对PT、PTT、血小板计数及混杂因素进行逻辑回归分析，以确定凝血功能障碍是否为全因死亡率的预测指标。
在20103例创伤登记队列患者中，14397例有完整的处置数据用于初始分析，7638例有最终分析中所有变量的完整数据。整个队列中男性占76.2%，平均年龄为38岁（范围1 - 108岁），损伤严重程度评分中位数为9分。共有1276例死亡（全因死亡率8.9%）。伤后早期凝血功能障碍的发生率很高，到达创伤病房时，28%的患者PT异常（10790例中的2994例），8%的患者PTT异常（10453例中的826例）。在有处置数据且PT正常的患者中，7796例中有489例死亡，而PT异常的2994例中有579例死亡（6.3%对19.3%；χ2 = 414.1，p < 0.001）。单因素分析得出PT异常时死亡的比值比为3.6（95%置信区间[CI]，3.15 - 4.08；p < 0.0001），PTT异常时死亡的比值比为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指标，而血小板计数不是。该模型还纳入了年龄、损伤严重程度评分、现场和创伤病房血压、血细胞比容、碱缺失和头部损伤等独立危险因素。该模型得出PT的调整比值比为1.35（95%CI，1.11 - 1.68；p < 0.001），PTT的调整比值比为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，即使存在其他危险因素，它们也是死亡率的独立预测指标。初始PT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%。
