| Title: | Hyperfibrinolysis in severe isolated traumatic brain injury may occur without tissue hypoperfusion : a retrospective observational multicentre study |
| Authors: | Hayakawa, Mineji Browse this author →KAKEN DB |
| Maekawa, Kunihiko Browse this author |
| Kushimoto, Shigeki Browse this author →KAKEN DB |
| Kato, Hiroshi Browse this author |
| Sasaki, Junichi Browse this author |
| Ogura, Hiroshi Browse this author →KAKEN DB |
| Matsuoka, Tetsuya Browse this author |
| Uejima, Toshifumi Browse this author |
| Morimura, Naoto Browse this author |
| Ishikura, Hiroyasu Browse this author |
| Hagiwara, Akiyoshi Browse this author |
| Takeda, Munekazu Browse this author |
| Kaneko, Naoyuki Browse this author |
| Saitoh, Daizoh Browse this author →KAKEN DB |
| Kudo, Daisuke Browse this author →KAKEN DB |
| Kanemura, Takashi Browse this author |
| Shibusawa, Takayuki Browse this author |
| Furugori, Shintaro Browse this author |
| Nakamura, Yoshihiko Browse this author |
| Shiraishi, Atsushi Browse this author |
| Murata, Kiyoshi Browse this author |
| Mayama, Gou Browse this author |
| Yaguchi, Arino Browse this author |
| Kim, Shiei Browse this author |
| Takasu, Osamu Browse this author |
| Nishiyama, Kazutaka Browse this author |
| Keywords: | Coagulopathy |
| Disseminated intravascular coagulation |
| Hypoperfusion |
| Hyperfibrinolysis |
| Traumatic brain injury |
| Issue Date: | 23-Aug-2017 |
| Publisher: | BioMed Central |
| Journal Title: | Critical care |
| Volume: | 21 |
| Start Page: | 222 |
| Publisher DOI: | 10.1186/s13054-017-1811-1 |
| Abstract: | Background: Hyperfibrinolysis is a critical complication in severe trauma. Hyperfibrinolysis is traditionally diagnosed via elevated D-dimer or fibrin/fibrinogen degradation product levels, and recently, using thromboelastometry. Although hyperfibrinolysis is observed in patients with severe isolated traumatic brain injury (TBI) on arrival at the emergency department (ED), it is unclear which factors induce hyperfibrinolysis. The present study aimed to investigate the factors associated with hyperfibrinolysis in patients with isolated severe TBI. Methods: We conducted a multicentre retrospective review of data for adult trauma patients with an injury severity score >= 16, and selected patients with isolated TBI (TBI group) and extra-cranial trauma (non-TBI group). The TBI group included patients with an abbreviated injury score (AIS) for the head >= 4 and an extra-cranial AIS < 2. The non-TBI group included patients with an extra-cranial AIS >= 3 and head AIS < 2. Hyperfibrinolysis was defined as a D-dimer level >= 38 mg/L on arrival at the ED. We evaluated the relationships between hyperfibrinolysis and injury severity/tissue injury/tissue perfusion in TBI patients by comparing them with non-TBI patients. Results: We enrolled 111 patients in the TBI group and 126 in the non-TBI group. In both groups, patients with hyperfibrinolysis had more severe injuries and received transfusion more frequently than patients without hyperfibrinolysis. Tissue injury, evaluated on the basis of lactate dehydrogenase and creatine kinase levels, was associated with hyperfibrinolysis in both groups. Among patients with TBI, the mortality rate was higher in those with hyperfibrinolysis than in those without hyperfibrinolysis. Tissue hypoperfusion, evaluated on the basis of lactate level, was associated with hyperfibrinolysis in only the non-TBI group. Although the increase in lactate level was correlated with the deterioration of coagulofibrinolytic variables (prolonged prothrombin time and activated partial thromboplastin time, decreased fibrinogen levels, and increased D-dimer levels) in the non-TBI group, no such correlation was observed in the TBI group. Conclusions: Hyperfibrinolysis is associated with tissue injury and trauma severity in TBI and non-TBI patients. However, tissue hypoperfusion is associated with hyperfibrinolysis in non-TBI patients, but not in TBI patients. Tissue hypoperfusion may not be a prerequisite for the occurrence of hyperfibrinolysis in patients with isolated TBI. |
| Rights: | http://creativecommons.org/licenses/by/4.0/ |
| Type: | article |
| URI: | http://hdl.handle.net/2115/67457 |
| Appears in Collections: | 北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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