Abstract：
Coagulopathy development in traumatic brain injury (TBI) is among the significant complications that can negatively affect the clinical course and outcome of TBI patients. Timely identification of this complication is of utmost importance in the acute clinical setting. We reviewed TBI patients admitted to our trauma center from 2015 to 2021. Demographic data, mechanism of injury, findings on admission, imaging studies, procedures during hospitalization, and functional outcomes were gathered. INR with a cutoff of 1.3, platelet count less than 100 × 10⁹/L, or partial thromboplastin time greater than 40s were utilized as the markers of coagulopathy. A total of 4002 patients were included. Coagulopathy occurred in 38.1% of the patients. Age of the patients (Odds Ratio (OR) = 0.993, 95% Confidence Interval (CI) = 0.986-0.999, p = 0.028), systolic blood pressure (OR = 0.993, 95% CI = 0.989-0.998, p = 0.005), fibrinogen level (OR = 0.998, 95% CI = 0.996-0.999, p < 0.001), and hemoglobin level (OR = 0.886, 95% CI = 0.839-0.936, p < 0.001) were independently associated with coagulopathy. Furthermore, coagulopathy was independently associated with higher mortality rates and longer ICU stays. Coagulopathy had the most substantial effect on mortality of TBI patients (OR = 2.6, 95% CI = 2.1-3.3, p < 0.001), compared to other admission clinical characteristics independently associated with mortality such as fixed pupillary light reflex (OR = 1.8, 95% CI = 1.5-2.4, p < 0.001), GCS (OR = 0.91, 95% CI = 0.88-0.94, p < 0.001), and hemoglobin level (OR = 0.93, 95% CI = 0.88-0.98, p = 0.004). Early coagulopathy in TBI patients can lead to higher mortality rates. Future studies are needed to prove that early detection and correction of coagulopathy and modifiable risk factors may help improve outcomes of TBI patients.
摘要：
创伤性脑损伤（TBI）中的凝血病发展是可能对TBI患者的临床病程和预后产生负面影响的重要并发症之一。在急性临床环境中，及时识别这种并发症至关重要。我们回顾了2015年至2021年入住我们创伤中心的TBI患者。人口统计数据,损伤机制,录取结果，影像学检查,住院期间的程序，并收集了功能结果。INR的临界值为1.3，血小板计数小于100×10/L，或部分凝血活酶时间大于40s被用作凝血病的标志物。共纳入4002例患者。38.1%的患者发生凝血病。患者年龄（赔率比（OR）=0.993，95％置信区间（CI）=0.986-0.999，p=0.028），收缩压（OR=0.993，95%CI=0.989-0.998，p=0.005），纤维蛋白原水平（OR=0.998，95％CI=0.996-0.999，p<0.001），和血红蛋白水平（OR=0.886，95％CI=0.839-0.936，p<0.001）与凝血病独立相关。此外，凝血病与较高的死亡率和较长的ICU住院时间独立相关。凝血障碍对TBI患者死亡率影响最大(OR=2.6,95%CI=2.1-3.3,p<0.001),与其他入院临床特征相比，与死亡率独立相关，如固定瞳孔光反射(OR=1.8，95%CI=1.5-2.4，p<0.001)，GCS（OR=0.91，95%CI=0.88-0.94，p<0.001），和血红蛋白水平（OR=0.93，95％CI=0.88-0.98，p=0.004）。TBI患者的早期凝血病会导致更高的死亡率。未来的研究需要证明早期发现和纠正凝血障碍和可改变的危险因素可能有助于改善TBI患者的预后。
