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. 2024 Jul 16;25(14):7763.
doi: 10.3390/ijms25147763.

Platelet Contribution and Endothelial Activation and Stress Index-Potential Mortality Predictors in Traumatic Brain Injury

Alexandru Emil Băetu  1   2 , Liliana Elena Mirea  1   3 , Cristian Cobilinschi  1   3 , Ioana Cristina Grințescu  4 , Ioana Marina Grințescu  1   3
Affiliations

Platelet Contribution and Endothelial Activation and Stress Index-Potential Mortality Predictors in Traumatic Brain Injury

Alexandru Emil Băetu et al. Int J Mol Sci. .

Abstract

Coagulopathy and traumatic brain injury (TBI) are complexly intertwined. In isolated TBI, coagulopathy may contribute to hemorrhagic lesion development, progression, or recurrence, as it may lead to a particular pattern of coagulopathy called TBI-induced coagulopathy (TBI-IC). We performed a retrospective and descriptive evaluation of 63 patients admitted to the Emergency Clinical Hospital Bucharest with the diagnosis of moderate/severe brain injury. In addition to demographic data, all included patients had a complete paraclinical evaluation that included rotational thromboelastometric (ROTEM) blood-clot analysis. The platelet component (PLTEM) and the endotheliopathy activation and stress index score (EASIX) were calculated. These parameters were presented comparatively according to survival at 30 days and helped define the two study groups: survivors and non-survivors at 30 days. The contribution of platelets to clot strength is derived from maximum clot elasticity (MCE) and maximum clot firmness (MCF). MCE is defined as (MCF × 100)/(100 - MCF), and PLTEM is defined as EXTEM MCE-FIBTEM MCE. EASIX is a novel biomarker recently studied in TBI patients, calculated according to the following formula: lactate dehydrogenase (U/L) × creatinine (mg/dL)/platelets (109 cells/L). Regarding the demographic data, there were no significant differences between the survivors and non-survivors. All ROTEM parameters related to clot amplitude (A5, A10, A20, MCF in EXTEM and FIBTEM channels) were higher in the group of patients who survived. Also, PLTEM was decreased in the group of deceased patients (89.71 ± 22.86 vs. 132.3 ± 16.56 p < 0.0001). The cut-off point determined with the ROC curve is 114.10, with a sensitivity of 94.74% and a specificity of 93.18%, for the detection of the negative prognosis (death at 30 days). The EASIX score was significantly higher in the patients who survived the traumatic event, with a median difference value of 1.15 (p < 0.0001). The ROC analysis of this biomarker highlights a cut-off point of 2.12, with a sensitivity of 88.64% and a specificity of 94.74% (AUC = 0.95, p < 0.0001), for the prediction of mortality. The comparative analysis of the two studied markers was performed using the Cox proportional hazard ratio and highlighted the greater influence that PLTEM has on survival time (b value = -0.05, p < 0.0001) compared to EASIX (b value = 0.49, p = 0.0026). The present retrospective study indicates the potential of the TBI-IC reflecting parameters PLTEM and EASIX as markers of mortality prognosis. Larger prospective studies are needed to confirm their combined prognostic value and use in decision-making and reduction in the burden of disease by adequate allocation of resources in a personalized and timely manner.

Keywords: EASIX; PLTEM; ROTEM; TBI-induced coagulopathy; clot elasticity; trauma-induced coagulopathy; traumatic brain injury.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Mean values comparison of A5, A10, A20—clot amplitude in millimeters at 5, 10, and 20 min; and MCF—maximum clot firmness between survivors (n = 44) and non-survivors (n = 19), EXTEM channel.
Figure 2
Figure 2
Mean values comparison of A5, A10, A20—clot amplitude in millimeters at 5, 10, and 20 min; and MCF—maximum clot firmness between survivors (n = 44) and non-survivors (n = 19), FIBTEM channel.
Figure 3
Figure 3
Mean values comparison of maximum clot elasticity (MCE) between survivors (n = 44) and non-survivors (n = 19), EXTEM channel.
Figure 4
Figure 4
Mean values comparison of maximum clot elasticity (MCE) between survivors (n = 44) and non-survivors (n = 19), FIBTEM channel.
Figure 5
Figure 5
Mean values comparison (dashed lines) of platelet contribution (PLTEM derived marker) between survivors (n = 44) and non-survivors (n = 19).
Figure 6
Figure 6
Receiver operating characteristics curve (ROC) of the PLTEM for predicting mortality in TBI patients.
Figure 7
Figure 7
Median values comparison of endothelial activation and stress index (EASIX) between survivors (n = 44) and non-survivors (n = 19).
Figure 8
Figure 8
Receiver operating characteristics curve (ROC) of the EASIX for predicting mortality in TBI patients.
Figure 9
Figure 9
ROC curves comparison—PLTEM vs. EASIX—Classification variable: death at 30 days. Hanley and McNeil analysis.
Figure 10
Figure 10
Spearman correlation of platelet contribution (PLTEM) and endothelial activation and stress index (EASIX).
See this image and copyright information in PMC

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