Impact of initial fibrinolytic marker in patients with traumatic brain injury

Abstract

Introduction/Objectives: Acute coagulopathy is a well-known predictor of poor outcomes in patients with traumatic brain injury (TBI). However, role of fibrinolytic markers with acute phase of TBI remains unclear. We analysed initial fibrinolytic abnormalities related poor outcome in patients with TBI. Methods: In this single centre, retrospective study, from January 2013 to May 2019, we identified 96 patients of independent TBI (Abbreviated Injury Score (AIS) –head of 3-5) with initial blood sample s obtained no more than 1h after injury. Of these, 27 patients had low plasma D-dimer (D-D) (<40μg/ml: Group L), and 20 patients had high plasma D-D (≧40μg/ml: Group H). Forty-nine patients were excluded in following condition (transfusion within 3h after injury, under taking anti-coagulation or anti-platelet, not-for-resuscitation or missing data). Measurement of plasma levels fibrinogen and D-dimer ware done in the emergency department on arrival as well as 3h following injury. We compared change of coagulopathy and neurological outcome between two groups. Glasgow-Outcome Scale (GOS) GR/MD at 1 month was defined as favourable neurological outcome, SD/VS/D was defined as unfavourable outcome. Results were expressed as median (IQR). Results: Initial plasma level of D-D were 15.2 μg/ml (7.1-20.3 [Group L]) and 62.3 μg/ml (53.2-93.9 [Group H]), and fibrinogen were not significantly different groups (232 mg/dl (193-268) [Group L] vs 256 (225-276) [Group H], P=0.67). Group H of change of plasma levels fibrinogen from initial to 3h after injury (⊿fibrinogen) were higher different than Group L (-20 μg/ml (-35- -6.5) [Group L] vs -67 (-89- -57) [Group H], P=0.42). There was a significant correlation between initial plasma level of D-D and ⊿fibrinogen (R2=0.6, P<0.05). Group L had a higher rate of favourable neurological outcome than Group H (96% (26/27) vs 35% (7/20); p<0.05. Conclusion: Fibrinolytic abnormalities are useful parameter for patients with acute phase of TBI, which may be a factor associated with poor prognosis.