Abstract
Background: The incidence of coagulopathy after open traumatic brain injury (TBI) is high. Coagulopathy can aggravate intracranial hemorrhage and further increase morbidity and mortality. The purpose of this study was to determine the clinical characteristics of coagulopathy after open TBI and its relationship with the prognosis. Methods: This study retrospectively evaluated patients with isolated open TBI from December 2018 to December 2020. Coagulopathy was defined as international normalized ratio (INR) > 1.2, activated thromboplastin time (APTT) > 35 s, or platelet count <100,000/μL. We compared the relationship between the clinical, radiological, and laboratory parameters of patients with and without coagulopathy, and the outcome at discharge. Logistic regression analysis was used to evaluate the risk factors associated with coagulopathy. We then compared the effects of treatment with and without TXA in open TBI patients with coagulopathy. Results: A total of 132 patients were included in the study; 46 patients developed coagulopathy. Patients with coagulopathy had significantly lower platelet levels (170.5 × 109/L vs. 216.5 × 109/L, p < 0.001), and significantly higher INR (1.14 vs. 1.02, p < 0.001) and APTT (30.5 s vs. 24.5 s, p < 0.001) compared to those with no coagulopathy. A Low Glasgow Coma Scale (GCS) score, high neutrophil/lymphocyte ratio (NLR), low platelet/lymphocyte ratio (PLR), and hyperglycemia at admission were significantly associated with the occurrence of coagulopathy. Conclusions: Coagulopathy often occurs after open TBI. Patients with a low GCS score, high NLR, low PLR, and hyperglycemia at admission are at greater risk of coagulopathy, and therefore of poor prognosis. The efficacy of TXA in open TBI patients with coagulopathy is unclear. In addition, these findings demonstrate that PLR may be a novel indicator for predicting coagulopathy.
Highlights
Traumatic brain injury (TBI) is one of the most common causes of death and disability worldwide, and can be divided into primary brain injury acting directly on the skull and secondary brain injury caused by initial trauma [1]
Patients with coagulopathy had lower Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores and higher mortality than those without coagulopathy, which suggests a correlation between coagulation parameters and open traumatic brain injury (TBI) severity and prognosis
Multivariate regression analysis revealed that coagulopathy was associated with GCS score, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and hyperglycemia
Summary
Traumatic brain injury (TBI) is one of the most common causes of death and disability worldwide, and can be divided into primary brain injury acting directly on the skull and secondary brain injury caused by initial trauma [1]. Coagulopathy can be divided into a hypocoagulable state characterized by prolonged bleeding and bleeding progression, and a hypercoagulable state characterized by an increased risk of thrombosis Both of these states can co-exist after TBI, a hypocoagulable state tends to be more common [6]; the clinical significance, pathophysiological mechanisms, and temporal relationship of these two phenotypes are unknown [6,7]. A recent prospective study [10] demonstrated that isolated TBI is consistent with coagulation changes in non-TBI patients and is characterized by disseminated intravascular coagulation with hyperactivity, that is, increased plasmin production and decreased antiplasmin levels These hypotheses lack strong clinical evidence, and the role of inflammatory parameters remains unclear. These findings demonstrate that PLR may be a novel indicator for predicting coagulopathy
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