Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom.
Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health National Health Service Trust, London, United Kingdom.
J Thromb Haemost. 2024 Mar;22(3):676-685. doi: 10.1016/j.jtha.2023.11.018. Epub 2023 Dec 7.
ABO blood group alters coagulation profiles in the general population and may influence outcomes after trauma. The relationship between trauma-induced coagulopathy, severe injury with hemorrhagic shock, and survival with respect to ABO group is unknown.
In severe hemorrhagic trauma, we aimed to characterize the association of ABO group with admission coagulation profiles, mortality, and immune-mediated complications.
Clinical and laboratory variables were examined from severely injured adult patients enrolled in a perpetual observational cohort study at a UK Major Trauma Center. Univariate and multivariate analyses were performed to determine differences in clinical outcomes (mortality, organ dysfunction, and critical care support). In a shock subgroup, we performed an exploratory analysis of rotational thromboelastometry parameters and coagulation biomarkers.
In 1119 trauma patients, we found no difference in mortality between ABO groups. In patients with shock, 24-hour mortality was significantly lower in group B vs non-B groups (7% vs 16%, adjusted odds ratio [aOR], 0.19; P = .030), but there were increased rates of invasive ventilation (aOR, 3.34; P = .033), renal replacement therapy (aOR, 2.55; P = .037), and a trend for infection (aOR, 1.85; P = .067). Comparing patients with shock, group B vs non-B patients had 40% higher fibrinogen, 65% higher factor (F) VIII, 36% higher FIX, 20% higher FXIII, and 19% higher von Willebrand factor.
In this observational study limited by single time-point sampling and subgroup analysis of trauma hemorrhage with shock, group B patients have enhanced hemostatic capability associated with early survival but with increased risk of immune-mediated complications.
ABO 血型会改变普通人群的凝血谱，并可能影响创伤后的结局。创伤性凝血病、伴有出血性休克的严重损伤以及与 ABO 组有关的存活率之间的关系尚不清楚。
在严重出血性创伤中，我们旨在描述 ABO 组与入院凝血谱、死亡率和免疫介导的并发症之间的关系。
对英国一家大型创伤中心进行的一项永久性观察队列研究中纳入的严重受伤成年患者的临床和实验室变量进行了检查。进行了单变量和多变量分析，以确定临床结局（死亡率、器官功能障碍和重症监护支持）的差异。在休克亚组中，我们对旋转血栓弹性图参数和凝血生物标志物进行了探索性分析。
在 1119 例创伤患者中，我们没有发现 ABO 组之间死亡率存在差异。在休克患者中，B 组 24 小时死亡率明显低于非 B 组（7%比 16%，调整后的优势比 [aOR]，0.19；P =.030），但有创性通气（aOR，3.34；P =.033）、肾脏替代治疗（aOR，2.55；P =.037）和感染的趋势（aOR，1.85；P =.067）的发生率增加。与休克患者相比，B 组患者的纤维蛋白原增加 40%，因子（F）VIII 增加 65%，FIX 增加 36%，FXIII 增加 20%，血管性血友病因子增加 19%。
在这项观察性研究中，由于仅进行了单次采样和对创伤性出血伴休克的亚组分析，B 组患者具有增强的止血能力，与早期存活率相关，但免疫介导的并发症风险增加。
