Department of Ortopedic Surgery, Aarhus University Hospital, 8200, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, 8000, Aarhus C, Denmark.
Sci Rep. 2023 Jan 30;13(1):1681. doi: 10.1038/s41598-023-28474-7.
Trauma-induced coagulopathy (TIC) is a risk factor for death and is associated with deviations in thrombin generation. TIC prevalence and thrombin levels increase with age. We assayed in vivo and ex vivo thrombin generation in injured patients (n = 418) to specifically investigate how age impacts thrombin generation in trauma and to address the prognostic ability of thrombin generation. Biomarkers of thrombin generation were elevated in young (< 40 years) and older (≥ 40 years) trauma patients. In vivo thrombin generation was associated with Injury Severity Score (ISS) and this association was stronger in young than older patients. In vivo thrombin generation decreased faster after trauma in the young than the older patients. Across age groups, in vivo thrombin generation separated patients dying/surviving within 30 days at a level comparable to the ISS score (AUC 0.80 vs. 0.82, p > 0.76). In vivo and ex vivo thrombin generation also predicted development of thromboembolic events within the first 30 days after the trauma (AUC 0.70-0.84). In conclusion, younger trauma patients mount a stronger and more dynamic in vivo thrombin response than older patients. Across age groups, in vivo thrombin generation has a strong ability to predict death and/or thromboembolic events 30 days after injury.
创伤诱导的凝血病（TIC）是死亡的危险因素，与凝血酶生成的偏差有关。TIC 的患病率和凝血酶水平随年龄增长而增加。我们对受伤患者（n=418）进行了体内和体外凝血酶生成检测，以专门研究年龄如何影响创伤中的凝血酶生成，并解决凝血酶生成的预后能力。年轻（<40 岁）和年长（≥40 岁）创伤患者的凝血酶生成生物标志物升高。体内凝血酶生成与损伤严重程度评分（ISS）相关，这种相关性在年轻患者中比年长患者更强。年轻患者创伤后体内凝血酶生成下降速度快于年长患者。在不同年龄组中，体内凝血酶生成能够区分在 30 天内死亡/存活的患者，其水平与 ISS 评分相当（AUC 0.80 与 0.82，p>0.76）。体内和体外凝血酶生成也预测了创伤后 30 天内血栓栓塞事件的发生（AUC 0.70-0.84）。总之，年轻的创伤患者比年长患者产生更强和更动态的体内凝血酶反应。在不同年龄组中，体内凝血酶生成具有很强的能力来预测受伤后 30 天内的死亡和/或血栓栓塞事件。
