Evaluation of Coagulopathy Frequency and Risk Factors in Trauma Patients in the Intensive Care Unit

Background: Posttraumatic coagulopathy is a common problem; however, the risk factors are not fully known. Objectives: This study aimed to retrospectively determine the frequency of coagulopathy related to trauma, as well as risk factors and their effects, on prognosis among patients admitted to the intensive care unit (ICU) after trauma. Methods: In total, 184 patients who were admitted to the 20-bed general adult ICU of Ankara Yildirim Beyazit University Medical Faculty Hospital between 2011 and 2017 after trauma were retrospectively analyzed. Two groups were selected by examining the laboratory results of the patients (considering the 1(st)- and 3(rd)-day platelet count), Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), and International Normalized Ratio (INR) values with and without trauma-associated coagulopathy. Results: The mean age of 184 patients included in the study was obtained at 41.77 +/- 16.91 years. The majority of the patients (n=149; 81%) were male. Coagulopathy was detected in 78 (42.4%) patients (on the first day [n=60; 32.6%] and on the third day [n=18; 9.8%]). It was found that patients with coagulopathy had more comorbidities (OR=3.080; %95 CI: 1.033-9.176), lower Glasgow Coma Score (GCS) (OR: 0.890; %95 CI: 0.827-0.957), lower Revised Trauma Score (RTS) (OR=0.699; %95 CI: 0.568-0.862), higher Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score (OR=1.092; %95 CI: 1.041-1.145), lower albumin values (OR:0.392; %95 CI: 0.203-0.758), and higher 28-day mortality (P<0.005), compared to patients without coagulopathy. Conclusion: In this study, co-morbidity, high APACHE-II, low GCS, RTS, and albumin levels were determined as independent risk factors for the development of post-traumatic coagulopathy. Since it is not possible to change the risk factors of critical trauma patients, such as GCS and co-morbidity, it is taught that the prevention of risk factors, such as hypoalbuminemia, with appropriate approaches can reduce the incidence of coagulopathy, as well as the mortality rate.