Mohammadzadeh Ibrahim, Niroomand Behnaz, Tajerian Amin, Shahnazian Zahra, Nouri Zahra, Mortezaei Ali
Skull Base Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
School of Medicine, Arak University of Medical Sciences, Arak, Iran.
Clin Neurol Neurosurg. 2025 Feb;249:108699. doi: 10.1016/j.clineuro.2024.108699. Epub 2024 Dec 25.
Progressive hemorrhagic injury (PHI) is a frequent complication of traumatic brain injury (TBI). This study aims to investigate the impact of coagulation factors (platelet [PLT], prothrombin time [PT], activated partial thromboplastin time [aPTT], international normalized ratio , fibrinogen [Fg], D-dimer [Dd], and fibrin [Fib]) at admission and PHI development through a comprehensive systematic review and meta-analysis based on PRISMA 2020 guideline. Databases including PubMed, Scopus, Web of Science, and Embase were searched up to March 2024. Controlled observational studies examining the relationship between coagulation tests at admission and PHI in isolated TBI cases were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist, and statistical analyses were performed using Stata software, employing Hedge's g to measure effect sizes. Sixteen studies encompassing 2411 TBI patients were included. Significant associations were found between decreased PLT (g = -0.243, P = 0.007), increased aPTT (g = 0.117, P = 0.037), increased INR (g = 0.217, P = 0.0202), elevated Dd levels (g = 1.57, P = 0.0084), and decreased Fg levels (g = -0.26, P = 0.0001) with the risk of developing PHI. PT showed no significant effect on PHI risk (g = 0.19, P = 0.0372). Our results suggest that elevated INR, Dd levels, and aPTT are linked to an increased risk of PHI. Conversely, higher PLT and Fg levels appear to be associated with a reduced PHI risk. Notably, Dd demonstrated stronger predictive power for PHI.
进行性出血性损伤（PHI）是创伤性脑损伤（TBI）的常见并发症。本研究旨在通过基于PRISMA 2020指南的全面系统评价和荟萃分析，探讨入院时凝血因子（血小板[PLT]、凝血酶原时间[PT]、活化部分凝血活酶时间[aPTT]、国际标准化比值、纤维蛋白原[Fg]、D-二聚体[Dd]和纤维蛋白[Fib]）与PHI发生发展之间的关系。检索了截至2024年3月的PubMed、Scopus、Web of Science和Embase等数据库。纳入了研究单纯性TBI病例入院时凝血检查与PHI之间关系的对照观察性研究。使用乔安娜·布里格斯研究所（JBI）清单评估偏倚风险，并使用Stata软件进行统计分析，采用Hedge's g来衡量效应大小。纳入了16项研究，共2411例TBI患者。发现PLT降低（g = -0.243，P = 0.007）、aPTT升高（g = 0.117，P = 0.037）、INR升高（g = 0.217，P = 0.0202）、Dd水平升高（g = 1.57，P = 0.0084）和Fg水平降低（g = -0.26，P = 0.0001）与发生PHI的风险显著相关。PT对PHI风险无显著影响（g = 0.19，P = 0.0372）。我们的结果表明，INR、Dd水平和aPTT升高与PHI风险增加有关。相反，较高的PLT和Fg水平似乎与降低的PHI风险相关。值得注意的是，Dd对PHI具有更强的预测能力。
