Risk factors and clinical significance of trauma-induced coagulopathy in ICU patients with severe trauma.

OBJECTIVE: To investigate the incidence and risk factors for trauma-induced coagulopathy (TIC) and the impact of TIC on outcomes of patients with severe trauma admitted to an emergency intensive care unit.

METHODS: We retrospectively reviewed clinical data from 223 patients with severe trauma admitted to emergency intensive care unit within 24 h after injury. Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II score, coagulation function, routine blood and biochemical tests, and blood gas parameters were obtained from medical records. Patients were divided into two groups according to the presence or absence of coagulopathy. ISS, Acute Physiology and Chronic Health Evaluation II score, and the incidence rates of hypothermia and tissue hypoperfusion were compared. The risk factors of TIC were analyzed and a multivariate logistic regression equation was developed. Coagulation function and the incidence of TIC were also compared between surviving and dead patients.

RESULTS: Overall, 52/223 (23.3%) patients fulfilled the diagnostic criteria for TIC. Their mortality rate was significantly higher than that of patients without coagulopathy (36.5 vs. 9.4%, P<0.01). ISS, incidence rates of hypothermia and tissue hypoperfusion, and the prevalence of severe traumatic brain injury were significantly higher (P<0.01), whereas Glasgow Coma Scale, hemoglobin, hematocrit, and platelet counts were significantly lower (P<0.01) in patients with coagulopathy than those without. Base deficit at least 6, Glasgow Coma Scale 8 or less, and platelet count were independent risk factors for TIC. Compared with surviving patients, the patients who died had significantly reduced coagulation function.

CONCLUSION: The incidence of TIC is particularly high among patients with severe trauma. TIC is associated with increased ISS, brain injury, shock and hypothermia, and mortality.