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. 2013 May;74(5):1223-9; discussion 1229-30.
doi: 10.1097/TA.0b013e31828b7fa1.

A principal component analysis of coagulation after trauma

Matthew E Kutcher  1 , Adam R Ferguson, Mitchell J Cohen
Affiliations

A principal component analysis of coagulation after trauma

Matthew E Kutcher et al. J Trauma Acute Care Surg. 2013 May.

Abstract

Background: Clotting factor abnormalities underlying acute traumatic coagulopathy are poorly understood, with application of traditional regression techniques confounded by colinearity. We hypothesized that principal components analysis (PCA), a pattern-finding and data reduction technique, would identify clinically predictive patterns in the complex clotting factor milieu after trauma.

Methods: Plasma was prospectively collected from 163 critically injured trauma patients. Prothrombin; factors V, VII, VIII, IX, X; D-dimer; activated and native protein C; and antithrombin III levels were assayed and subjected to nonlinear PCA to identify principal components (PCs).

Results: Of 163 patients, 19.0% were coagulopathic on admission. PCA identified 3 significant PCs, accounting for 67.5% of overall variance. PC1 identified global clotting factor depletion; PC2 the activation of protein C and fibrinolysis; and PC3 factor VII elevation and VIII depletion. PC1 score correlated with penetrating injury and injury severity, predicting coagulopathy (odds ratio [OR], 4.67; p < 0.001) and mortality (OR, 1.47; p = 0.032). PC2 score correlated with injury severity, acidosis, and shock, and significantly predicted ventilator-associated pneumonia (OR, 1.59; p = 0.008), acute lung injury (OR, 2.24; p < 0.001), multiorgan failure (OR, 1.83; p = 0.002), and mortality (OR, 1.62; p = 0.006) but was not associated with international normalized ratio (INR)-based or partial thromboplastin time (PTT)-based coagulopathy (p > 0.200). PC3 did not significantly predict outcomes.

Conclusion: PCA identifies distinct patterns of coagulopathy: depletion coagulopathy predicts mortality and INR/PTT elevation, while fibrinolytic coagulopathy predicts infection, end-organ failure, and mortality, without detectable differences in INR or PTT. While depletion coagulopathy is intuitive, fibrinolytic coagulopathy may be a distinct but often overlapping entity with differential effects on outcomes.

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Figures

Figure 1
Figure 1
Plots of patient scores within multivariate principal component space, by binary outcomes. Representative two-dimensional (PC1-PC2 space) plots provided. (a) International normalized ratio (INR) ≤ 1.3, (b) partial thromboplastin time (PTT) ≤ 30, (c) multiorgan failure, and (d) mortality. Markers indicate outcome status (filled circles = absence, hollow circles = presence).
Figure 1
Figure 1
Plots of patient scores within multivariate principal component space, by binary outcomes. Representative two-dimensional (PC1-PC2 space) plots provided. (a) International normalized ratio (INR) ≤ 1.3, (b) partial thromboplastin time (PTT) ≤ 30, (c) multiorgan failure, and (d) mortality. Markers indicate outcome status (filled circles = absence, hollow circles = presence).
Figure 1
Figure 1
Plots of patient scores within multivariate principal component space, by binary outcomes. Representative two-dimensional (PC1-PC2 space) plots provided. (a) International normalized ratio (INR) ≤ 1.3, (b) partial thromboplastin time (PTT) ≤ 30, (c) multiorgan failure, and (d) mortality. Markers indicate outcome status (filled circles = absence, hollow circles = presence).
Figure 1
Figure 1
Plots of patient scores within multivariate principal component space, by binary outcomes. Representative two-dimensional (PC1-PC2 space) plots provided. (a) International normalized ratio (INR) ≤ 1.3, (b) partial thromboplastin time (PTT) ≤ 30, (c) multiorgan failure, and (d) mortality. Markers indicate outcome status (filled circles = absence, hollow circles = presence).
See this image and copyright information in PMC

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