Publication:

Coagulation profile tests as a predictor for adult trauma patients’ mortality

Background Coagulopathy is commonly observed in poly-traumatized patients and is a known contributor to trauma mortality. Although, the incidence of coagulopathy is strongly associated with the severity of the injury, coagulopathy itself exerts an independent factor on mortality.

Methods This is a prospective, observational study on 100 trauma patients. All patients were evaluated using the modified shock index (MSI). Coagulation profile tests including platelet count, prothrombin time (PT), partial thromboplastin time (PTT), D-dimer and fibrinogen/fibrin degradation products (FDPs) were performed for all patients on admission and at 12 hours intervals. Statistically, a logistic regression analysis was performed of coagulation profile tests to determine the incidence of trauma induced coagulopathy (TIC) and its impact on 24 hours mortality. Correlation between clinical and laboratory status was done.

Results There was a statistically significant difference between the dead and the survived patients in the coagulation profile tests and MSI. The best cut-off point of each parameter of coagulation profile tests (PLT count, PT, PTT, d-dimer, FDPs) and MSI was calculated using receiver operating characteristic curve and were 18.7 s, >31 s, >5 mg/l, > 321.5 mg/l and 1.6 respectively. Trauma induced coagulopathy in our study was defined by more than 2 of the following: PLT 18.7 s, activated partial thromboplastin time (APTT) >31 s, D-dimer >5 mg/l and FDPs>321.5 mg/l with a p value 0.001 and associated with increased mortality.

Conclusions The incidence of trauma induced coagulopathy early after trauma is high and its severity is related to the injury itself. It is independent predictor of mortality. TIC was developed with presence of more than 2 of the coagulopathy parameters.