Trauma induced coagulopathy is limited to only one out of four shock induced endotheliopathy (SHINE) phenotypes among moderate-severely injured trauma patients: an exploratory analysis

被引：2

作者：

Johansson, Par I. ^{[1
,2
,3
]}

Vigstedt, Martin ^{[1
,2
]}

Curry, Nicola S. ^{[4
,5
]}

Davenport, Ross ^{[6
]}

Juffermans, Nicole P. ^{[7
]}

Stanworth, Simon J. ^{[5
,8
]}

Maegele, Marc ^{[9
]}

Gaarder, Christine ^{[10
]}

Brohi, Karim ^{[6
]}

Stensballe, Jakob ^{[1
,2
,11
,12
]}

Henriksen, Hanne H. ^{[1
,2
]}

机构：

[1] Copenhagen Univ Hosp, CAG Ctr Endotheli, Rigshosp, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

[2] Copenhagen Univ Hosp, Dept Clin Immunol, Rigshosp, Copenhagen, Denmark

[3] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark

[4] Oxford Univ Hosp NHS Fdn Trust, Oxford Haemophilia & Thrombosis Ctr, Oxford, England

[5] Univ Oxford, Radcliffe Dept Med, Oxford, England

[6] Queen Mary Univ London, Blizard Inst, Barts & London Sch Med & Dent, Trauma Sci, London, England

[7] Univ Amsterdam, Dept Intens Care Med, Amsterdam UMC, Amsterdam, Netherlands

[8] Oxford Univ Hosp NHS Fdn Trust, John Radcliffe Hosp, NHS Blood & Transplant, Oxford, England

[9] Univ Witten Herdecke, Cologne Merheim Med Ctr, Dept Traumatol & Orthopaed Surg, Cologne, Germany

[10] Oslo Univ Hosp, Dept Traumatol, Oslo, Norway

[11] Copenhagen Univ Hosp, Dept Anesthesiol, Rigshosp, Copenhagen, Denmark

[12] Copenhagen Univ Hosp, Trauma Ctr, Rigshosp, Copenhagen, Denmark

来源：

SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE | 2024年 / 32卷 / 01期

关键词：

Trauma; Shock induced endotheliopathy; Hierarchical clustering; Coagulopathy; GLYCOCALYX DEGRADATION; SYNDECAN-1; ACTIVATION; MORTALITY; MARKER;

D O I：

10.1186/s13049-024-01236-8

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundTrauma induced coagulopathy remains to be an important cause of high transfusion requirements and mortality and shock induced endotheliopathy (SHINE) has been implicated.MethodsEuropean multicenter observational study of adult trauma patients with injury severity score >= 16 arriving within 2 h from injury to the trauma centers. Admission blood samples obtained were used for analysis of the SHINE biomarkers (syndecan-1, soluble thrombomodulin, adrenaline) and extensive analysis of coagulation, -and fibrinolytic factors together with collection of clinical data. Hierarchical clustering of the SHINE biomarkers was used to identify the SHINE phenotypes.ResultsThe 313 patients clustered into four SHINE phenotypes. Phenotype 2, having the highest glycocalyx shedding, encompassing 22% of the whole cohort, had severe coagulopathy with lower levels of prothrombin, FV, IX, X, XI and severe hyperfibrinolysis with higher plasmin - alpha 2-antiplasmin (PAP) - and tPA levels and lower alpha2 - antiplasmin levels. This phenotype had significantly higher transfusion requirements and higher mortality (39% vs. 23%, 15% and 14%) but similar injury severity score (ISS) compared to the others phenotypes.ConclusionsHierarchical clustering identified four SHINE phenotype in a cohort of trauma patients. Trauma induced coagulopathy was confined to only one of the SHINE phenotypes, encompassing 22% of the total cohort. This phenotype was characterized by severe hypocoagulability and hyperfibrinolysis, which translated to significantly higher transfusion requirements and higher mortality compared to the other SHINE phenotypes with similar injury severity, warranting further investigation.

引用

页数：11

共 27 条

[11] Acute coagulopathy of trauma: Balancing progressive catecholamine induced endothelial activation and damage by fluid phase anticoagulation [J].