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. 2022 Aug;48(4):2751-2761.
doi: 10.1007/s00068-022-01882-6. Epub 2022 Feb 3.

Is it possible to improve prediction of outcome and blood requirements in the severely injured patients by defining categories of coagulopathy?

Jean-Stéphane David  1   2 , Arnaud Friggeri  3 , Charles-Hervé Vacheron  3 , Pierre Bouzat  4 , Laurie Fraticelli  5   6 , Clément Claustre  5   6 , Marc Maegele  7 , Kenji Inaba  8
Affiliations

Is it possible to improve prediction of outcome and blood requirements in the severely injured patients by defining categories of coagulopathy?

Jean-Stéphane David et al. Eur J Trauma Emerg Surg. 2022 Aug.

Abstract

Purpose: It has been suggested to define the Trauma-induced coagulopathy (TIC) with a PTratio threshold of 1.20. We hypothesized that a more pragmatic classification would grade severity according to the PTratio (or corresponding ROTEM clotting time: EXTEM-CT), and that this would correlate better with the need for blood products (BP) and prognosis.

Methods: Retrospective analysis of prospectively collected data of 1076 severely injured patients admitted from 01/2011 to 12/2019 in a university hospital. To determine the number of TIC categories and the best PTratio or EXTEM-CT thresholds for mortality at 24-h, a modified Mazumdar approach was used. Multivariate regression analyses were done to describe the relationship between PTratio and ROTEM parameter subclasses with mortality.

Results: Three thresholds were, respectively, identified for PTratio (1.20, 1.90 and 3.00) and EXTEM-CT (90 s, 130 s, 200 s). The following categories were defined for PTratio: ≤ 1.20 (No TIC), 1.21-1.90 (Moderate TIC), 1.91-3.00 (severe TIC), > 3.00 (major TIC); and for EXTEM-CT: < 91 s (no TIC), 91-130 s (moderate TIC), 131-200 s (severe TIC) and > 200 s (major TIC). We observed that when the PTratio (or EXTEM-CT) increased, mortality and BP requirements increased. After multiple adjustments, we observed that each subclass of PTratio and EXTEM-CT was independently associated with mortality at 24-h.

Conclusion: In this study, we have described a pragmatic classification of coagulopathy utilizing PTratio and EXTEM-CT where increasing severity was associated with prognosis and the amount of BP administered. This could allow clinicians to better predict the outcome and anticipate the need for blood products.

Keywords: Blood products; Coagulopathy; Injury; Outcome; ROTEM.

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