A retrospective analysis of severe multiple trauma with secondary thrombocytosis

Abstract

Objective To estimate the clinic features of severe multiple trauma with secondary thrombocytosis as a factor influencing the prognosis. Methods A retrospective single-center study was carried out in 680 patients with severe multiple trauma survived longer than 72 hours in Chongqing Emergency Medical Center from March 2010 through March 2013. The variables including age, gender, ISS (injury severity score) , APACHE Ⅱ score, splenectomy and the usages of vasopressors, blood products transfusion, hematopoietic medicines and anticoagulant were analyzed. The prognosis indices including total in-hospital mortality after 72 hours, length of hospital stay and morbidity of thrombo-embolism were explored. The clinic characteristics and prognosis of severe multiple trauma with secondary thrombocytosis (platelet count more than 450 ×109L-1) were evaluated. T test or rank sum test was used for comparison between measurement data and Chi-square test or Fisher's exact test was used for comparison between enumeration data. Results Thrombocytosis was identified in 99 (14.56%) patients and it occurred one week after injury with median time of 27 days (ranged from 8 days to 304 days) , and maintained for (18.62 ±4.38) d. The median of platelet count was 584 × 109L-1 (lowest 478 × 109L-1, highest 1 072 ×109L-1) in severe multiple trauma patients with thrombocytosis. The proportions of splenectomy, prolonged use of vasopressors and employment of hematopoietic medicines or anticoagulant were significantly higher in patients with thrombocytosis than those in patients without thrombocytosis (14.14% vs.7.06% , P =0.03; 62.63% vs.39.07%, P <0.01; 28.28% vs.6.71%, P <0.01; 90.91% vs.19.45% , P< 0.01) . The highest D-Dimer level presenting in patients with thrombocytosis during the time of platelet increasing was significantly more common than that in patients of non-thrombocytosis group 7 days after trauma [(11.68 ±11.90) vs. (5.05 ±5.11) , P =0.004]. However, the mortality, length of hospital stay and morbidity of thrombo-embolism were not significantly increased in patients with thrombocytosis compared with patients without thrombocytosis [8.08% vs.8.78% , P =0.82; 34 d (28.5, 54.5) d vs. 45 d (23, 67) d, P =0.41; 10.10% vs.10.50% , P =0.91]. Conclusion There was a higher rate of secondary thrombocytosis in severe multiple trauma patients. The factors such as splenectomy, vasopressors, hematopoietic medicines and so on might induce the reactive thrombocytosis in trauma patients. Thrombocytosis might increase the incidence of thromboembolism in severe multiple trauma patients without appropriate prophylactic anticoagulation. For the sake of prophylaxis, employment of anti-platelet agent might be the appropriately therapeutic strategy for patients suffering from severe multiple trauma with secondary thrombocytosis accompanying risk factors of arterial thrombo-embolism. Key words: Multiple trauma; Thrombocytosis; Thromboembolism; Anticoagulation; Prognosis