Acute Crit Care.  2018 Aug;33(3):162-169. 10.4266/acc.2018.00199.

Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma

Affiliations
  • 1Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. jrmr9933@gmail.com
  • 2Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea.
  • 3Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.

Abstract

BACKGROUND
Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma.
METHODS
Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed.
RESULTS
During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P < 0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality.
CONCLUSIONS
Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma.

Keyword

coagulopathy; fibrinolysis; hemorrhage; thromboelastometry; trauma

MeSH Terms

Acidosis
Fibrinolysis
Hemorrhage
Humans
Korea
Lactic Acid
Mortality*
Thrombelastography*
Lactic Acid
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