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

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.

Figure 1

International Normalized Ratio (INR) of patients and control group. 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). The Mann-Whitney U-test was performed with ^∗∗ P = 0.001.

Figure 2

Partial Thromboplastin Time (PTT) of patients and control group. 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). The Mann-Whitney U-test was performed with ^∗ P < 0.05.

Figure 3

Calcium levels of patients and control group. 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). The Mann-Whitney U-test was performed with ^∗∗ P < 0.0001.

Figure 4

Fibrinogen levels of patients and control group. 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). The Mann-Whitney U-test was performed to test for differences.

Figure 5

Clotting factor activities of patients and control group. 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). The Mann-Whitney U-test was performed with ^∗∗ P < 0.01.

Figure 6

Clotting factor activities of survivors and nonsurvivors after multiple trauma. 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 (survivors versus nonsurvivors).

Figure 7

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).

Figure 8

Clotting factor activities at admission after multiple trauma and the need for hemostatic therapy. 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 (hemostatic versus nonhemostatic therapy within hospital stay).

Figure 9

Clotting factor activities after multiple trauma according to amount of preclinical fluid resuscitation. 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 (<1500 versus >1500 mL of preclinical fluid volume).