Persistent fibrinolysis shutdown is associated with increased mortality in traumatic pancreatic injury |
| |
Affiliation: | 1. Division of Trauma and Surgical Critical Care, Dignity Health Medical Group, 45 S. Dobson Rd., Ste. 201, Chandler, AZ, 85224, USA;2. East Valley General Surgical Residency Program, Dignity Health Medical Group, 45 S. Dobson Rd., Ste. 201, Chandler, AZ, 85224, USA;1. Department of Surgery, Harlem Hospital Center, Columbia, University, New York, NY, USA;2. Department of Plastic Surgery, Harlem Hospital Center, Columbia, University, New York, NY, USA;3. Department of Surgery, Division of Trauma, Harlem Hospital Center, Columbia University, New York, NY, USA;1. Department of Emergency, Akita Red Cross Hospital 222-1, Kamikitatesarutanawasirosawa, Akita 010-1495, Japan;2. Department of Emergency, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan;3. Department of Plastic Surgery, Akita Red Cross Hospital 222-1, Kamikitatesarutanawasirosawa, Akita 010-1495, Japan;4. Department of Pediatrics, Tohoku University Seiryo-Machi 1, Aoba-ku, Sendai 980-8574, Japan;1. Division of Acute Care Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte NC, USA;2. Morehouse School of Medicine, Atlanta, GA, USA;3. University of South Florida Morsani College of Medicine, Tampa, FL, USA;1. Department of digestive surgery, CHU Félix Guyon, allée des Topazes, Saint Denis 97400, France;2. 5th Armed Forces Medical Center, 42 rue Lauth, Strasbourg 67000, France;3. Department of digestive surgery, Begin Military Teaching Hospital, 69 avenue de Paris, Saint Mandé 94160, France;4. Intensive Care Unit, Percy Military Teaching Hospital, 101 avenue Henri Barbusse, Clamart 92140, France;5. Val de Grace Academy, 1 Place Alphonse Laveran, Paris 75005, France |
| |
Abstract: | PurposeThe features of fibrinolytic system modifications and their relationship with prognosis are still unknown in traumatic pancreatic injury. The object of this prospective cohort research was to identify fibrinolytic characteristics in patients with pancreatic trauma and to identify the correlation to mortality.MethodA prospective screening of traumatic pancreatic injury patients was done for five years. The fibrinolytic status of patients was determined by thromboelastography (TEG). The percentage reduction in clot strength 30 min (LY30) after the time of maximal clot strength was utilized to distinguish the fibrinolytic phenotype of individuals, including fibrinolytic shutdown (SD), physiologic fibrinolysis (PHYS) and hyperfibrinolysis (HF). Two cohorts, transient fibrinolytic shutdown (TSD) and persistent fibrinolytic shutdown (PSD), were divided according to whether fibrinolytic shutdown persisted within one week. Demographics, injury severity, characteristics of pancreatic injury, treatment, and outcomes were compared.ResultA total of 180 cases enrolled, aged 42(interquartile range 32–51) years, 88% males, 97% were blunt trauma. The median ISS was 19(IQR 10–25), and 76% were AAST grade III to V (high-grade). At admission, there were 159 cases of SD (88%), 15 cases of PHYS (8%) while 6 cases of HF (3%). Of these, the TSD cohort included 54 patients (34%), while the PSD cohort included 105 patients (66%). Compared with the TSD cohort, the PSD cohort had more severe injury (ISS 21[IQR 12–27] vs 16[IQR 9–22], p = 0.006) and a higher proportion of AAST high-grade (83% vs 67%, p = 0.035). Persistent fibrinolytic shutdown was associated with operative treatment (odds ratio [OR] 3.111; 95%CI 1.146–8.447; p = 0.026), associated intra-abdominal injury (OR 8.331; 95% CI 1.301–53.336; p = 0.025) and admission LY30 (OR 0.016; 95% CI 0.002 - 0.120; p < 0.001). It was an independent predictor of mortality (adjusted odds ratio [AOR] 4.674; 95% CI 1.03 to 21.14; p = 0.045).ConclusionFibrinolytic shutdown especially persistence of this phenotype is more common in traumatic pancreatic injury than PHYS and HF, which related with mortality. Risk factors including LY30 at admission, intra-abdominal injury and operative treatment were associated with the persistent fibrinolytic shutdown. Sheltered the patients from these risk factors seems to be beneficial, which need to be confirmed by further large-scale studies. |
| |
Keywords: | |
本文献已被 ScienceDirect 等数据库收录! |
|