Analysis of risk factors for trauma-induced coagulopathy in elderly major trauma patients

Yangbo Kang; Qi Yang; Hongbo Ding; Yufeng Hu; Jiasheng Shen; Feng Ruan; Bojin Chen; Yiping Feng; Yuchen Jin; Shanxiang Xu; Libing Jiang; Guirong Wang; Yong'an Xu

doi:10.5847/wjem.j.1920-8642.2024.093

Analysis of risk factors for trauma-induced coagulopathy in elderly major trauma patients

World J Emerg Med. 2024;15(6):475-480. doi: 10.5847/wjem.j.1920-8642.2024.093.

Authors

Yangbo Kang^{1

2

3}, Qi Yang^{1

2

3}, Hongbo Ding^{1

2

3}, Yufeng Hu^{1

2

3}, Jiasheng Shen^{1

2

3}, Feng Ruan^{1

2

3}, Bojin Chen^{1

2

3}, Yiping Feng^{1

2

3}, Yuchen Jin^{1

2

3

4}, Shanxiang Xu^{1

2

3}, Libing Jiang^{1

2

3}, Guirong Wang⁵, Yong'an Xu^{1

2

3}

Affiliations

¹ Department of Emergency Medicine, the Second Affiliated Hospital Zhejiang University School of Medicine / Institute of Emergency Medicine of Zhejiang University, Hangzhou 310009, China.
² Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burns of Zhejiang Province, Hangzhou 310009, China.
³ Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou 310009, China.
⁴ Department of Emergency Medicine, Huzhou Central Hospital, Huzhou 313002, China.
⁵ Department of Surgery, State University of New York Upstate Medical University, New York 13210, USA.

Abstract

Background: Trauma-induced coagulopathy (TIC) due to serious injuries significantly leads to increased mortality and morbidity among elderly patients. However, the risk factors of TIC are not well elucidated. This study aimed to explore the risk factors of TIC in elderly patients who have major trauma.

Methods: In this retrospective study, the risk factors for TIC in elderly trauma patients at a single trauma center were investigated between January 2015 and September 2020. The demographic information including gender, age, trauma parts, injury severity, use of blood products, use of vasopressors, need of emergency surgery, duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and hospital, and clinical outcomes were extracted from electric medical records. Multivariate logistic regression analysis was performed to differentiate risk factors, and the performance of the model was evaluated using receiver operating characteristics (ROC) curves.

Results: Among the 371 elderly trauma patients, 248 (66.8%) were male, with the age of 72.5 ± 6.8 years, median injury severity score (ISS) of 24 (IQR: 17-29), and Glasgow coma score (GCS) of 14 (IQR: 7-15). Of these patients, 129 (34.8%) were diagnosed with TIC, whereas 242 (65.2%) were diagnosed with non-TIC. The severity scores such as ISS (25 [20-34] vs. 21 [16-29], P<0.001) and shock index (SI), (0.90±0.66 vs. 0.58 ± 0.18, P<0.001) was significantly higher in the TIC group than in the non-TIC group. Serum calcium levels (1.97±0.19 mmol/L vs. 2.15±0.16 mmol/L, P<0.001), fibrinogen levels (1.7±0.8 g/L vs. 2.8±0.9 g/L, P<0.001), and base excess (BE, -4.9±4.6 mmol/L vs. -1.2 ± 3.1 mmol/L, P<0.001) were significantly lower in the TIC group than in the non-TIC group. Multivariate logistic regression analysis revealed that ISS>16 (OR: 3.404, 95%CI: 1.471-7.880; P=0.004), SI>1 (OR: 5.641, 95%CI: 1.700-18.719; P=0.005), low BE (OR: 0.868, 95%CI: 0.760-0.991; P=0.037), hypocalcemia (OR: 0.060, 95%CI: 0.009-0.392; P=0.003), and hypofibrinogenemia (OR: 0.266, 95%CI: 0.168-0.419; P<0.001) were independent risk factors for TIC in elderly trauma patients. The AUC of the prediction model included all these risk factors was 0.887 (95%CI: 0.851-0.923) with a sensitivity and specificity of 83.6% and 82.6%, respectively.

Conclusion: Higher ISS (more than 16), higher SI (more than 1), acidosis, hypocalcemia, and hypofibrinogenemia emerged as independent risk factors for TIC in elderly trauma patients.

Keywords: Elderly patients; Hypocalcemia; Trauma; Trauma-induced coagulopathy.