Prognostic value of disseminated intravascular coagulation in patients with traumatic brain injury

Abstract

Objective To evaluate the role of disseminated intravascular coagulation (DIC) for prognosis prediction in patients with traumatic brain injury (TBI). Methods The retrospective review collected 209 patients with moderate to severe TBI (admission GCS score of 3-12 points) emergently admitted between January 2010 and January 2014. DIC score was calculated for each patient according to the modified diagnostic criteria for DIC by the International Society of Thrombosis and Hemostasis (international DIC score) and for DIC by the Japanese Ministry of Health and Welfare (Japanese DIC score) respectively. A receiver-operating characteristic (ROC) curve analysis based on the two DIC scores was made to calculate the area under curve (AUC) for prediction of progressive hemmorhage injury (PHI) and prognosis. Results AUC (95%CI) of Japanese DIC score was 0.847(0.795-0.898), indicating a higher predictive value of PHI over other single coagulation index. International DIC score and Japanese DIC score for 6-month mortality [AUC 0.734 (95%CI 0.644-0.824) and AUC 0.708 (95%CI 0.612-0.804), respectively] and for 6-month unfavorable outcome [AUC 0.640 (95%CI 0.566-0.714) and 0.606 (95%CI 0.530-0.682), respectively] showed higher predictive value compared to other single coagulation index. When the international DIC score and Japanese DIC score were added into the predictive model of motality, the AUC were increased to 0.811 (95%CI 0.741-0.880) and 0.795 (95%CI 0.722-0.868) respectively. Conclusions Predictive value of DIC score for PHI and prognosis in TBI patients is higher than other single coagulation index. Combination of DIC score with traditional predictive model can increase the prediction ability on mortality of the TBI patients. Key words: Craniocerebral trauma; Disseminated intravascular coagulation; Prognosis; Forecasting