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Evaluation of Potential Clinical Surrogate Markers of a Trauma Induced Alteration of Clotting Factor Activities.

Burggraf M, Payas A, Schoeneberg C, Wegner A, Kauther MD, Lendemans S - Biomed Res Int (2016)

Bottom Line: Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission.Conclusions.Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Emergency Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.

ABSTRACT
Objective. The aim of this study was to identify routinely available clinical surrogate markers for potential clotting factor alterations following multiple trauma. Methods. In 68 patients admitted directly from the scene of the accident, all soluble clotting factors were analyzed and clinical data was collected prospectively. Ten healthy subjects served as control group. Results. Patients showed reduced activities of clotting factors II, V, VII, and X and calcium levels (all P < 0.0001 to 0.01). Levels of hemoglobin and base deficit correlated moderately to highly with the activities of a number of clotting factors. Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission. In contrast, factor VIII activity was markedly elevated after injury in general (P < 0.0001), but reduced in nonsurvivors (P < 0.05). Conclusions. Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general. Initial hemoglobin and, with certain qualifications, base deficit levels demonstrated a potential value in detecting those underlying clotting factor deficiencies. Nevertheless, their role as triggers of a hemostatic therapy as well as the observed response of factor VIII to multiple trauma and also its potential prognostic value needs further evaluation.

No MeSH data available.


Related in: MedlinePlus

Clotting factor activities after multiple trauma and preclinical intubation. Fib: fibrinogen; Ca: calcium. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). Logarithmic ordinate for better depiction. The Mann-Whitney U-test was performed with ∗P < 0.05 and ∗∗P < 0.01 (intubation versus nonintubation).
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fig7: Clotting factor activities after multiple trauma and preclinical intubation. Fib: fibrinogen; Ca: calcium. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). Logarithmic ordinate for better depiction. The Mann-Whitney U-test was performed with ∗P < 0.05 and ∗∗P < 0.01 (intubation versus nonintubation).

Mentions: Figures 6–9 present the differences related to survival, intubation, hemostatic therapy, and prehospital volume replacement. In contrast to survivors, nonsurvivors had significantly reduced activities of FII (66 versus 84%, P < 0.01), FV (54 versus 84%, P < 0.01), FVIII (141 versus 231%, P < 0.05), and FXIII (69 versus 88%, P < 0.05). If patients needed intubation prior to admission, the serum levels of fibrinogen (222 versus 242 mg/dL, P < 0.01) and calcium (2.06 versus 2.20 mmol/L, P < 0.01) as well as the activities of FII (75 versus 90%, P < 0.01), FV (71 versus 88%, P < 0.01), FVIII (164 versus 237%, P < 0.05), FIX (83 versus 103%, P < 0.01), FX (85 versus 92%, P < 0.01), FXI (91 versus 108%, P < 0.01), and FXII (79 versus 99%, P < 0.01) were reduced significantly. Patients who were in need for hemostatic therapy over the course had significantly reduced levels and activities of all soluble clotting factors but FVII (71 versus 91%, P = 0.06), FVIII (151 versus 216%, P = 0.35), and FXIII (73 versus 93%, P = 0.05). If the amount of prehospital volume replacement exceeded 1500 mL, levels of fibrinogen (203 versus 237 mg/dL, P < 0.01) and calcium (2.06 versus 2.16 mmol/L, P < 0.01) as well as activities of FII (77 versus 87%, P < 0.05), FVII (66 versus 92%, P < 0.05), FX (77 versus 90%, P < 0.01), FXI (91 versus 108%, P < 0.05), and FXII (87 versus 99%, P < 0.05) were decreased significantly.


Evaluation of Potential Clinical Surrogate Markers of a Trauma Induced Alteration of Clotting Factor Activities.

Burggraf M, Payas A, Schoeneberg C, Wegner A, Kauther MD, Lendemans S - Biomed Res Int (2016)

Clotting factor activities after multiple trauma and preclinical intubation. Fib: fibrinogen; Ca: calcium. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). Logarithmic ordinate for better depiction. The Mann-Whitney U-test was performed with ∗P < 0.05 and ∗∗P < 0.01 (intubation versus nonintubation).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940535&req=5

fig7: Clotting factor activities after multiple trauma and preclinical intubation. Fib: fibrinogen; Ca: calcium. The results are presented by using boxplots. Bottom and top of the box indicate the 25th and 75th percentile, called interquartile range (IR). The median is represented by the horizontal bar within the box. Whiskers indicate spread (1.5 times IR). Logarithmic ordinate for better depiction. The Mann-Whitney U-test was performed with ∗P < 0.05 and ∗∗P < 0.01 (intubation versus nonintubation).
Mentions: Figures 6–9 present the differences related to survival, intubation, hemostatic therapy, and prehospital volume replacement. In contrast to survivors, nonsurvivors had significantly reduced activities of FII (66 versus 84%, P < 0.01), FV (54 versus 84%, P < 0.01), FVIII (141 versus 231%, P < 0.05), and FXIII (69 versus 88%, P < 0.05). If patients needed intubation prior to admission, the serum levels of fibrinogen (222 versus 242 mg/dL, P < 0.01) and calcium (2.06 versus 2.20 mmol/L, P < 0.01) as well as the activities of FII (75 versus 90%, P < 0.01), FV (71 versus 88%, P < 0.01), FVIII (164 versus 237%, P < 0.05), FIX (83 versus 103%, P < 0.01), FX (85 versus 92%, P < 0.01), FXI (91 versus 108%, P < 0.01), and FXII (79 versus 99%, P < 0.01) were reduced significantly. Patients who were in need for hemostatic therapy over the course had significantly reduced levels and activities of all soluble clotting factors but FVII (71 versus 91%, P = 0.06), FVIII (151 versus 216%, P = 0.35), and FXIII (73 versus 93%, P = 0.05). If the amount of prehospital volume replacement exceeded 1500 mL, levels of fibrinogen (203 versus 237 mg/dL, P < 0.01) and calcium (2.06 versus 2.16 mmol/L, P < 0.01) as well as activities of FII (77 versus 87%, P < 0.05), FVII (66 versus 92%, P < 0.05), FX (77 versus 90%, P < 0.01), FXI (91 versus 108%, P < 0.05), and FXII (87 versus 99%, P < 0.05) were decreased significantly.

Bottom Line: Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission.Conclusions.Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Emergency Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.

ABSTRACT
Objective. The aim of this study was to identify routinely available clinical surrogate markers for potential clotting factor alterations following multiple trauma. Methods. In 68 patients admitted directly from the scene of the accident, all soluble clotting factors were analyzed and clinical data was collected prospectively. Ten healthy subjects served as control group. Results. Patients showed reduced activities of clotting factors II, V, VII, and X and calcium levels (all P < 0.0001 to 0.01). Levels of hemoglobin and base deficit correlated moderately to highly with the activities of a number of clotting factors. Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission. In contrast, factor VIII activity was markedly elevated after injury in general (P < 0.0001), but reduced in nonsurvivors (P < 0.05). Conclusions. Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general. Initial hemoglobin and, with certain qualifications, base deficit levels demonstrated a potential value in detecting those underlying clotting factor deficiencies. Nevertheless, their role as triggers of a hemostatic therapy as well as the observed response of factor VIII to multiple trauma and also its potential prognostic value needs further evaluation.

No MeSH data available.


Related in: MedlinePlus