Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi-shi, Saitama 333-0833, Japan.
Int J Mol Sci. 2020 Aug 5;21(16):5613. doi: 10.3390/ijms21165613.
Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3-6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the "elderly group," aged ≥75 y) and younger patients (the "non-elderly group," aged 16-74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3-6 h post-injury, and D-dimer levels between admission and 3-6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.
凝血障碍和年龄较大是创伤性脑损伤（TBI）患者预后较差的常见且公认的危险因素；然而，凝血障碍与年龄之间的关系仍不清楚。我们假设凝血/纤维蛋白溶解异常在老年患者中更为明显，可能是预后较差的一个因素。我们回顾性评估了入院时和受伤后 3-6 小时测量纤维蛋白原和 D-二聚体的严重 TBI 病例。采用倾向评分匹配分析来调整老年患者（“老年组”，年龄≥75 岁）和年轻患者（“非老年组”，年龄 16-74 岁）之间的基线特征。共评估了 1294 例病例（老年组：395 例，非老年组：899 例），并通过倾向评分匹配创建了 324 对匹配队列。入院时纤维蛋白原、入院至伤后 3-6 小时纤维蛋白原减少程度以及入院至伤后 3-6 小时 D-二聚体水平在老年组均显著高于非老年组。多变量逻辑回归分析表明，预后不良的独立危险因素包括入院时纤维蛋白原水平低和 D-二聚体水平高。创伤后凝血和纤维蛋白溶解异常在老年患者中更为严重，纤维蛋白原和 D-二聚体异常是负预测因素。
