Analysis of risk factors and prognosis in patients with hyperfibrinolysis after severe trauma / 中华创伤杂志

ABSTRACT

Objective:To Analyze the risk factors and prognosis of patients with hyperfibrinolysis after severe trauma.Methods:A prospective case-control study was conducted to analyze the clinical data of severe trauma patients whose injury severity score (ISS)≥16 points admitted to First People's Hospital of Taicang from October 2017 to December 2018. Blood clot dissolution rate parameter (LY30) ≥3% was diagnosed as hyperfibrinolysis. The patients were divided into hyperfibrinolysis group ( n=27) and non-hyperfibrinolysis group ( n=27). Data were collected including patients' general information, hemoglobin (Hb), hematocrit (Hct), platelet count (PLT), fibrinogen (Fg), lactic acid value and thrombelastograghy (TEG). Univariate and multivariate Logistic regression analysis were used to identify risk factors of hyperfibrinolysis after severe trauma. Prognostic indicators and K-M survival curve of the patients were analyzed. Results:(1) A total of 142 patients with severe trauma were enrolled. There were 101 males and 41 females, aged 45-65 years (mean, 56 years). The incidence of hyperfibrinolysis was 14.8%. (2) Univariate analysis showed that ISS, abbreviated injury scale (AIS) ratio of pelvic limbs ≥3 points, shock index (SI) ratio >1, temperature, PLT, Fg and lactic acid value were correlated with the occurrence of hyperfibrinolysis after severe trauma ( P<0.05). (3) Multivariate Logistic regression analysis showed that PLT ( OR=1.035), ISS ( OR=0.898) and lactate acid value ( OR=0.735) were independent risk factors for hyperfibrinolysis after severe trauma ( P<0.05 or 0.01). (4) Hyperfibrinolysis group required more massive transfusion (38.1% vs. 2.5%), were more prone to multiple organ dysfunction syndrome (MODS) (90.5% vs. 48.8%), and had a higher 24-hour mortality (47.6% vs. 8.3%), when compared with non-hyperfibrinolysis group ( P<0.01). K-M survival curve indicated that the median survival time in hyperfibrinolysis group after trauma was 1.33 days ( IQR, 0.40-17.20 days). Conclusions:The incidence of hyperfibrinolysis after severe trauma is low. ISS, PLT and lactic acid value are the independent risk factors for hyperfibrinolysis after severe trauma. Patients with severe post-traumatic hyperfibrinolysis are characterized by high probabilities of massive transfusion and MODS, short survival time and high early mortality.