Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Anesthesiology and Intensive Care, Grigore Alexandrescu Clinical Emergency Hospital for Children, 011743 Bucharest, Romania.
Int J Mol Sci. 2024 Jul 16;25(14):7763. doi: 10.3390/ijms25147763.
Coagulopathy and traumatic brain injury (TBI) are complexly intertwined. In isolated TBI, coagulopathy may contribute to hemorrhagic lesion development, progression, or recurrence, as it may lead to a particular pattern of coagulopathy called TBI-induced coagulopathy (TBI-IC). We performed a retrospective and descriptive evaluation of 63 patients admitted to the Emergency Clinical Hospital Bucharest with the diagnosis of moderate/severe brain injury. In addition to demographic data, all included patients had a complete paraclinical evaluation that included rotational thromboelastometric (ROTEM) blood-clot analysis. The platelet component (PLTEM) and the endotheliopathy activation and stress index score (EASIX) were calculated. These parameters were presented comparatively according to survival at 30 days and helped define the two study groups: survivors and non-survivors at 30 days. The contribution of platelets to clot strength is derived from maximum clot elasticity (MCE) and maximum clot firmness (MCF). MCE is defined as (MCF × 100)/(100 - MCF), and PLTEM is defined as EXTEM MCE-FIBTEM MCE. EASIX is a novel biomarker recently studied in TBI patients, calculated according to the following formula: lactate dehydrogenase (U/L) × creatinine (mg/dL)/platelets (10 cells/L). Regarding the demographic data, there were no significant differences between the survivors and non-survivors. All ROTEM parameters related to clot amplitude (A5, A10, A20, MCF in EXTEM and FIBTEM channels) were higher in the group of patients who survived. Also, PLTEM was decreased in the group of deceased patients (89.71 ± 22.86 vs. 132.3 ± 16.56 < 0.0001). The cut-off point determined with the ROC curve is 114.10, with a sensitivity of 94.74% and a specificity of 93.18%, for the detection of the negative prognosis (death at 30 days). The EASIX score was significantly higher in the patients who survived the traumatic event, with a median difference value of 1.15 ( < 0.0001). The ROC analysis of this biomarker highlights a cut-off point of 2.12, with a sensitivity of 88.64% and a specificity of 94.74% (AUC = 0.95, < 0.0001), for the prediction of mortality. The comparative analysis of the two studied markers was performed using the Cox proportional hazard ratio and highlighted the greater influence that PLTEM has on survival time (b value = -0.05, < 0.0001) compared to EASIX (b value = 0.49, = 0.0026). The present retrospective study indicates the potential of the TBI-IC reflecting parameters PLTEM and EASIX as markers of mortality prognosis. Larger prospective studies are needed to confirm their combined prognostic value and use in decision-making and reduction in the burden of disease by adequate allocation of resources in a personalized and timely manner.
凝血障碍与创伤性脑损伤（TBI）之间存在复杂的相互关系。在单纯性 TBI 中，凝血障碍可能导致出血性病变的发展、进展或复发，因为它可能导致一种特定的凝血障碍模式，称为创伤性脑损伤诱导的凝血障碍（TBI-IC）。我们对布加勒斯特急诊临床医院收治的 63 例诊断为中度/重度脑损伤的患者进行了回顾性和描述性评估。除了人口统计学数据外，所有纳入的患者都进行了完整的临床评估，包括旋转血栓弹性测定（ROTEM）血液凝块分析。计算了血小板成分（PLTEM）和内皮病变激活和应激指数评分（EASIX）。根据 30 天的生存情况对这些参数进行了比较，并帮助确定了两个研究组：30 天存活者和非存活者。血小板对血凝块强度的贡献来自最大血凝块弹性（MCE）和最大血凝块硬度（MCF）。MCE 的定义为（MCF×100）/（100-MCF），PLTEM 的定义为 EXTEM MCE-FIBTEM MCE。EASIX 是一种最近在 TBI 患者中研究的新型生物标志物，根据以下公式计算：乳酸脱氢酶（U/L）×肌酐（mg/dL）/血小板（10 个细胞/L）。关于人口统计学数据，存活者和非存活者之间没有显著差异。在存活组中，与血凝块幅度相关的所有 ROTEM 参数（A5、A10、A20、EXTEM 和 FIBTEM 通道中的 MCF）均较高。此外，死亡组的 PLTEM 降低（89.71±22.86 vs. 132.3±16.56 <0.0001）。ROC 曲线确定的截断值为 114.10，检测阴性预后（30 天内死亡）的灵敏度为 94.74%，特异性为 93.18%。EASIX 评分在创伤事件中存活的患者中显著升高，中位数差值为 1.15（<0.0001）。该生物标志物的 ROC 分析突出了 2.12 的截断值，灵敏度为 88.64%，特异性为 94.74%（AUC=0.95，<0.0001），可预测死亡率。使用 Cox 比例风险比对两种研究标记物进行了比较分析，并强调 PLTEM 对生存时间的影响大于 EASIX（b 值=-0.05，<0.0001）（b 值=0.49，=0.0026）。本回顾性研究表明，TBI-IC 反映参数 PLTEM 和 EASIX 作为死亡率预后标志物具有潜力。需要更大规模的前瞻性研究来证实它们的联合预后价值，并在决策中使用它们，通过及时和个性化地分配资源来降低疾病负担。
