J Korean Soc Emerg Med.  2004 Oct;15(5):399-405.

Correlation of the Serum Antithrombin III to Injury Severity in Patients with Severe Trauma

• Ji HJ
• Lee KH
• Kim SH
• Oh SB
• Cha KC
• Kim HJ
• Kim H
• Hwang SO

Abstract

PURPOSE
Antithrombin III (AT-III) is a serum protease inhibitor that inhibits the blood coagulation protease thrombin and is seen to be present in low levels in cases of shock, sepsis, or major trauma. Coagulopathy and hemorrhage are known contributors to trauma prognosis but the actual relationships of AT-III to mortality and to injury severity are unknown. The purpose of this study was to determine the correlation between AT-III and injury severity.
METHODS
This study was a retrospective analysis of data collection from January 1, 2003, to December 31, 2003. Sixty patients with multiple trauma were studied. The revised trauma score (RTS), the injury severity score (ISS), the systemic inflammatory response syndrome score (SIRS), the acute physiology and chronic health evaluation III (APACHE III), the length of ICU stay, the base-deficit value and the serum lactate were measured to evaluate injury severity. We estimated the relation between the severity of injury and the serum level of AT-III.
RESULTS
In patients with multiple trauma, the serum AT-III level was lower in the non-survival group (12.6 mg/dL) than it was in the survival group (17.2 mg/dL) (p=0.004). Among the previous injury severity evaluation system, the unit of transfusion for 24 hours had the strongest correlation with AT-III (R=0.546, p=0.000). The base deficit (R=0.418, p=0.001), the length of ICU stay (R=0.415, p=0,030), the APACHE III (R=0.367, p=0.021), and the RTS (R=0.247, p=0.006) were also correlated with AT-III. A logistic regression showed a strong association between the AT-III level and the mortality rate (mortality rate = 1.067- 0.370 x AT -III, p= 0.004).
CONCLUSION
In patients with severe trauma, The serum AT-III level was correlated with the RTS, the APACHE III, the number of transfusion units, the severity of shock, and the length of ICU stay. The serum AT-III level also showed a strong correlation with mortality.

Keyword

Trauma; Antithrombin-III; Disseminated intravascular coagulation; Injury severity score

MeSH Terms

Antithrombin III*
APACHE
Blood Coagulation
Data Collection
Disseminated Intravascular Coagulation
Hemorrhage
Humans
Injury Severity Score
Lactic Acid
Logistic Models
Mortality
Multiple Trauma
Prognosis
Protease Inhibitors
Retrospective Studies
Sepsis
Shock
Systemic Inflammatory Response Syndrome
Thrombin
Antithrombin III
Lactic Acid
Protease Inhibitors
Thrombin