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Objective To investigate the value of thromboelastography ( TEG) in evaluating the prognosis of polytrauma patients. Methods A retrospective case control study was conducted to analyze the clinical data of 155 polytrauma patients admitted to 94th Hospital of People's Liberation Army from September 2015 to December 2017. There were 118 males and 37 females, aged 18-88 years [(49. 0 ± 1. 3)years]. Injury severity score (ISS) was (26. 4 ± 11. 0)points. According to the prognosis of patients 90 days after injury, the patients were divided into survival group ( 143 patients ) and death group (12 patients). The ISS on admission, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Glasgow coma score ( GCS ) , systolic blood pressure ( SBP ) , respiratory rate ( RR ) and outcome of 90 days after injury were collected. Red blood cells( RBC) , hemoglobin( Hb) , plasma prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , fibrinogen ( FIB) , international normalized ratio ( INR) , thrombin time ( TT) , platelet count ( PLT) and TEG-related indicators within 2 hours after ICU admission were collected. TEG-related indicators including TCG clotting reaction time ( R ) , clot formation rate (K), clot formation kinetics (α angle), maximum amplitude (MA), coagulation index (CI), blood clotting strength (G), elasticity constant (E) and clot lysis time (CLT) were collected within 2 hours after admission to ICU. The changes of TEG-related indicators were compared between the two groups, and logistic regression analysis and receiver operating characteristic ( ROC) curve analysis were performed. Results Compared with the survival group, ISS and APACHE II scores in the death group were significantly higher, while GCS, SBP, RR, RBC and Hb were significantly lower (P<0. 05). Compared with the survival group, death group showed significantly prolonged PT [(21. 1 ± 9. 1) s vs. (16. 5 ± 4. 3)s] as well as reduced FIB [(1. 7 ± 1. 5)g/L vs. (2. 7 ± 1. 7)g/L] (P<0. 05). Compared with the survival group, the K value in the death group was significantly prolonged [5. 2(1. 8,8. 0)min vs. 2. 9(2. 1,4. 2)min] (P<0. 05). Compared with the survival group, death group showed significant decrease in G value (3762. 4 ± 3346. 7 vs. 6366. 5 ± 3886. 1), E value (75. 3 ± 67. 0 vs. 127. 3 ± 77.7),αangle[(38.4±19.7)°vs. (49.4±16.6)°],MA[(37.4±17.5)mmvs.(52.0±13.3)mm], CI [-6. 8(-9. 5, 1. 5) vs. -2. 9 ( -5. 9, -0. 7)] and CLT [39. 2 (32. 5, 46. 9) min vs. 46. 4 (32. 7, 60.8) min] (P<0. 05). There were no significant differences in APTT, TT, INR, PLT and R between the two groups (P>0. 05). Logistic regression analysis showed that MA was significantly associated with the prognosis of polytrauma patients (OR=1. 15, 95％ CI 1. 04-1. 28, P<0. 05). The area under the ROC curve of MA was 0. 756 (P <0. 05). When the MA threshold was 43. 1 mm, the sensitivity, specificity, positive predictive value and negative predictive value of predicted survival were 77. 5％, 76. 9％, 76. 1％ and 97. 3％, respectively. Conclusion TEG index MA can determine the prognosis of polytrauma patients, and the mortality rate is significantly increased at MA<43. 1 mm.
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Objective The platelet function changes are closely related to the prognosis of trauma patients and the occurrence of coagulopathy. The purpose of this paper is to investigate the clinical value of platelet function changes in trauma patients for prognosis judgment. Methods The clinical data of 94 trauma patients admitted to the Department of Critical Care Medicine, 908th Hospital from July 2017 to February 2019 were retrospectively analyzed. According to the 90-day prognosis of patients, the patients were divided into survival group (n=80) and death group (n=14) to compare the traditional coagulation function indexes, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), fibrinogen degradation product (FDP), D-dimer, antithrombin II (I ATIII), thromboelastogram (TEG) index [coagulation reaction time (R), clot formation rate (K), clot formation kinetics (α angle), maximum clot strength (MA), etc.] and platelet aggregation function index [arachidonic acid (AA) platelet aggregation rate and adenosine diphosphate (ADP) Platelet aggregation rate]. The data was analyzed by receiver operating characteristic (ROC) curve analysis and Kaplan-Meier analysis. Results Compared with the survival group, the APPT, R value and K value prolonged significantly in the death group (P<0.05). However, the MA value，AA-induced and ADP-induced platelet aggregation decreased significantly in the death group (P<0.05). The ROC curve analysis showed that when the MA cut-off value was 42.05mm, the sensitivity, specificity, positive predictive value and negative predictive value were 83.8%, 71.4%, 58.3% and 94.2% respectively. When the cut-off value of AA platelet aggregation rate was 36.6%, the sensitivity, specificity, positive predictive value and negative predictive value were 57.5%, 85.7%, 75.5% and 93.8% respectively. When the cut-off value of ADP platelet aggregation rate was 29.3%, the sensitivity, specificity, positive predictive value and negative predictive value were 70%, 64.3%, 72.7% and 91.8% respectively. The death risk of patients with AA-induced aggregation rate < 36.6% was 4.37 times that of the patients with AA-induced platelet aggregation rate ≥ 36.6% (95% CI: 1.34 to 10.98). The death risk of patients with ADP-induced aggregation rate < 29.3% was 3.674 times that of the patients with ADP-induced platelet aggregation rate ≥ 29.3% (95%CI:1.385~ 12.880). The death risk of trauma patients with MA < 42.05 mm was 9.759 times that of the patients with MA ≥ 42.05 mm (95% CI: 6.674 ~ 89.87). Conclusion The platelet function of trauma patients can be significantly impaired. When the MA, AA platelet aggregation rate and ADP platelet aggregation rate are lower, the mortality rate of trauma patients becomes higher. The platelet function index of MA, AA and ADP can be used to determine the prognosis of trauma patients.
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Objective Coagulation disorder is an independent risk factor of death in trauma patients. This study aimed to investigate the prognostic value of thromboelastography (TEG) for patients with trauma-induced coagulopathy.Methods This retrospective study included 124 cases of trauma-induced coagulopathy treated in our Department of Critical Care Medicine from September 2015 to July 2018. We collected the clinical data and laboratory Results of the patients within 2 hours after admission, divided the patients into a survival group (n=108) and death group (n=16) according to their 90-day prognosis after trauma, and compared the TEG parameters between the two groups. Using logistic regression analysis and ROC curves, we identified the optimal prognostic factors and compared the platelet (PLT) count and mortality rate among those with different cut-off values.Results In comparison with the survival group, the death group showed a significant increase in the clot formation time (CFT) (3.2 \[2.2-4.8\] vs 5.2 \[5.0-9.8\] min, P45.65 mm (86 \[46-114\] vs 116 \[84-171\]×109/L, P<0.05), and mortality was remarkably higher in the former than in the latter group (31.8% vs 1.2%, P<0.05).Conclusion Among the TEG parameters, MA / maximal clot strength is a valuable indicator for the prognosis of trauma-induced coagulopathy, and MA<45.65 mm indicates early PLT dysfunction and poor prognosis.
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Objective To observe the therapeutic effect of therapy of tonifying kidney,activating bone-marrow, and unblocking collaterals for patients with chronic aplastic anemia (CAA), and to investigate its effect on thromboelastogram platelet maximum amplitude (Ma) value for exlporing its therapeutic mechanism. Methods Sixty CAA patients were randomized into trial group and control group, 30 cases in each group. The control group was given oral use of Stanozolol and Cyclosporin A, and the trial group was orally given the recipe with the actions of tonifying kidney,activating bone-marrow,and unblocking collaterals,which is mainly composed of Radix Rehmanniae,Radix Rehmanniae Preparata,Caulis Spatholobi,Semen Cuscutae,Fructus Lycii,Radix Angelicae Sinensis, Fructus Ligustri Lucidi, Herba Ecliptae, Pheretima, and Semen Strychni Preparata. The clinical efficacy was evaluated after treatment,and peripheral hemogram and thromboelastogram Ma value of the two groups were compared before and after treatment. Results (1)The trial group had better western medicine therapeutic effect and traditional Chinese medicine (TCM)syndrome therapeutic effect than the control group, the difference being signficant (P < 0.01).(2) After treatment, TCM syndrome scores, parameters of blood routine test,thromboelastogram Ma value of the two groups were improved compared with those before treatment (P < 0.05 or P < 0.01),and the improvement in the trial group was superior to that in the control group (P <0.05). Conclusion Therapy of tonifying kidney, activating bone-marrow, and unblocking collaterals is effective on improving blood coagulation function by increasing the quality and amount of platelet.