Platelet Contribution and Endothelial Activation and Stress Index-Potential Mortality Predictors in Traumatic Brain Injury.

Publisher: MDPI Country of Publication: Switzerland NLM ID: 101092791 Publication Model: Electronic Cited Medium: Internet ISSN: 1422-0067 (Electronic) Linking ISSN: 14220067 NLM ISO Abbreviation: Int J Mol Sci Subsets: MEDLINE

Original Publication: Basel, Switzerland : MDPI, [2000-

Brain Injuries, Traumatic*/mortality ; Brain Injuries, Traumatic*/blood ; Brain Injuries, Traumatic*/complications ; Brain Injuries, Traumatic*/physiopathology ; Blood Platelets*/metabolism; Humans ; Male ; Female ; Middle Aged ; Adult ; Retrospective Studies ; Thrombelastography ; Aged ; Prognosis ; Biomarkers/blood ; Blood Coagulation Disorders/etiology ; Blood Coagulation Disorders/mortality ; Blood Coagulation Disorders/blood

Coagulopathy and traumatic brain injury (TBI) are complexly intertwined. In isolated TBI, coagulopathy may contribute to hemorrhagic lesion development, progression, or recurrence, as it may lead to a particular pattern of coagulopathy called TBI-induced coagulopathy (TBI-IC). We performed a retrospective and descriptive evaluation of 63 patients admitted to the Emergency Clinical Hospital Bucharest with the diagnosis of moderate/severe brain injury. In addition to demographic data, all included patients had a complete paraclinical evaluation that included rotational thromboelastometric (ROTEM) blood-clot analysis. The platelet component (PLTEM) and the endotheliopathy activation and stress index score (EASIX) were calculated. These parameters were presented comparatively according to survival at 30 days and helped define the two study groups: survivors and non-survivors at 30 days. The contribution of platelets to clot strength is derived from maximum clot elasticity (MCE) and maximum clot firmness (MCF). MCE is defined as (MCF × 100)/(100 - MCF), and PLTEM is defined as EXTEM MCE-FIBTEM MCE. EASIX is a novel biomarker recently studied in TBI patients, calculated according to the following formula: lactate dehydrogenase (U/L) × creatinine (mg/dL)/platelets (10 ⁹ cells/L). Regarding the demographic data, there were no significant differences between the survivors and non-survivors. All ROTEM parameters related to clot amplitude (A5, A10, A20, MCF in EXTEM and FIBTEM channels) were higher in the group of patients who survived. Also, PLTEM was decreased in the group of deceased patients (89.71 ± 22.86 vs. 132.3 ± 16.56 p < 0.0001). The cut-off point determined with the ROC curve is 114.10, with a sensitivity of 94.74% and a specificity of 93.18%, for the detection of the negative prognosis (death at 30 days). The EASIX score was significantly higher in the patients who survived the traumatic event, with a median difference value of 1.15 ( p < 0.0001). The ROC analysis of this biomarker highlights a cut-off point of 2.12, with a sensitivity of 88.64% and a specificity of 94.74% (AUC = 0.95, p < 0.0001), for the prediction of mortality. The comparative analysis of the two studied markers was performed using the Cox proportional hazard ratio and highlighted the greater influence that PLTEM has on survival time (b value = -0.05, p < 0.0001) compared to EASIX (b value = 0.49, p = 0.0026). The present retrospective study indicates the potential of the TBI-IC reflecting parameters PLTEM and EASIX as markers of mortality prognosis. Larger prospective studies are needed to confirm their combined prognostic value and use in decision-making and reduction in the burden of disease by adequate allocation of resources in a personalized and timely manner.

Transfusion. 2022 Aug;62 Suppl 1:S281-S300. (PMID: 35748694)
Anesth Analg. 2015 Oct;121(4):868-878. (PMID: 26378699)
Int J Surg. 2024 May 16;:. (PMID: 38752515)
Lancet Neurol. 2017 Aug;16(8):630-647. (PMID: 28721927)
Neurocrit Care. 2015 Feb;22(1):45-51. (PMID: 25127903)
Brain Inj. 2012;26(9):1136-42. (PMID: 22630115)
Shock. 2017 Dec;48(6):644-650. (PMID: 28614144)
Platelets. 2016 Dec;27(8):751-757. (PMID: 27164510)
J Neurotrauma. 2012 Nov 20;29(17):2597-605. (PMID: 23020190)
Cancer Biomark. 2022;35(2):217-225. (PMID: 36120771)
Front Neurol. 2018 Jan 26;9:15. (PMID: 29434566)
J Cardiothorac Vasc Anesth. 2020 Mar;34(3):640-649. (PMID: 31699598)
Crit Care. 2011;15(1):R2. (PMID: 21208418)
Blood Coagul Fibrinolysis. 2011 Jul;22(5):416-9. (PMID: 21467918)
Med Sci Monit. 2020 Jul 04;26:e922879. (PMID: 32620738)
BMC Cancer. 2020 Aug 24;20(1):803. (PMID: 32831058)
J Neurotrauma. 2023 Jul;40(13-14):1366-1375. (PMID: 37062757)
J Emerg Trauma Shock. 2013 Jul;6(3):180-5. (PMID: 23960374)
Lancet Neurol. 2022 Nov;21(11):1004-1060. (PMID: 36183712)
Syst Rev. 2023 Nov 22;12(1):221. (PMID: 37990333)
Am J Hematol. 2014 Feb;89(2):228-32. (PMID: 24123050)
Korean J Anesthesiol. 2015 Jun;68(3):241-8. (PMID: 26045926)
J Trauma Acute Care Surg. 2014 May;76(5):1169-76. (PMID: 24747445)
J Neurotrauma. 2011 Oct;28(10):2033-41. (PMID: 21942848)
Crit Care Explor. 2021 Sep 14;3(9):e0526. (PMID: 34549189)
J Clin Med. 2023 Mar 28;12(7):. (PMID: 37048641)
Neurol India. 2024 Mar 1;72(2):285-291. (PMID: 38691471)
Blood. 2018 May 3;131(18):2001-2006. (PMID: 29507078)
J Neurotrauma. 2017 Jan 1;34(1):192-203. (PMID: 26757855)
Neurocrit Care. 2024 Apr;40(2):448-476. (PMID: 38366277)
Crit Care. 2019 Mar 27;23(1):98. (PMID: 30917843)
Thromb Haemost. 2011 Aug;106(2):322-30. (PMID: 21655681)
Front Med (Lausanne). 2021 Nov 15;8:767637. (PMID: 34869481)
J Trauma. 2011 Aug;71(2 Suppl 3):S337-42. (PMID: 21814101)
Ann Lab Med. 2024 Jan 1;44(1):74-81. (PMID: 37665288)
Scand J Trauma Resusc Emerg Med. 2016 Oct 3;24(1):114. (PMID: 27716278)
Intensive Care Med. 2021 Jan;47(1):49-59. (PMID: 33048195)
J Trauma. 2009 Nov;67(5):959-67. (PMID: 19901655)
Anesth Analg. 2019 Mar;128(3):414-423. (PMID: 29944523)
Neurocrit Care. 2016 Jun;24(3):361-70. (PMID: 26293923)
Front Physiol. 2023 Feb 27;14:1094845. (PMID: 36923287)
Eur J Med Res. 2024 May 29;29(1):300. (PMID: 38807251)
Ann Surg. 2016 Jun;263(6):1051-9. (PMID: 26720428)
Neurosurgery. 2017 Jan 01;80(1):6-15. (PMID: 27654000)
BMJ Open. 2023 Oct 6;13(10):e075049. (PMID: 37802626)
J Clin Med. 2021 Oct 28;10(21):. (PMID: 34768556)

Keywords: EASIX; PLTEM; ROTEM; TBI-induced coagulopathy; clot elasticity; trauma-induced coagulopathy; traumatic brain injury

0 (Biomarkers)

Date Created: 20240727 Date Completed: 20240727 Latest Revision: 20240729

20240729

PMC11276696

10.3390/ijms25147763

39063005