Prediction of venous thromboembolism using clinical and serum biomarker data from a military cohort of trauma patients

IntroductionVenous thromboembolism (VTE) is a frequent complication of trauma associated with high mortality and morbidity. Clinicians lack appropriate tools for stratifying trauma patients for VTE, thus have yet to be able to predict when to intervene. We aimed to compare random forest (RF) and logistic regression (LR) predictive modelling for VTE using (1) clinical measures alone, (2) serum biomarkers alone and (3) clinical measures plus serum biomarkers.MethodsData were collected from 73 military casualties with at least one extremity wound and prospectively enrolled in an observational study between 2007 and 2012. Clinical and serum cytokine data were collected. Modelling was performed with RF and LR based on the presence or absence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). For comparison, LR was also performed on the final variables from the RF model. Sensitivity/specificity and area under the curve (AUC) were reported.ResultsOf the 73 patients (median Injury Severity Score=16), nine (12.3%) developed VTE, four (5.5%) with DVT, four (5.5%) with PE, and one (1.4%) with both DVT and PE. In all sets of predictive models, RF outperformed LR. The best RF model generated with clinical and serum biomarkers included five variables (interleukin-15, monokine induced by gamma, vascular endothelial growth factor, total blood products at resuscitation and presence of soft tissue injury) and had an AUC of 0.946, sensitivity of 0.992 and specificity of 0.838.ConclusionsVTE may be predicted by clinical and molecular biomarkers in trauma patients. This will allow the development of clinical decision support tools which can help inform the management of high-risk patients for VTE.

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Changes of the Blood Lymphocytes On Severe Trauma Patients in Early Time

10.21203/rs.3.rs-298978/v1 ◽

2021 ◽

Author(s):

Feng Cao ◽

Ru He ◽

Yan Huang ◽

Zi Li ◽

Xiaoheng Wu ◽

...

Keyword(s):

Lymphocyte Count ◽

Injury Severity ◽

Tissue Injury ◽

Area Under The Curve ◽

Early Time ◽

Trauma Patients ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Secondary Tissue ◽

Severe Tissue

Abstract Purpose: To evaluate the relationship between the change of blood lymphocyte counts in early stages of trauma patients and the secondary tissue injury after trauma. Method: A retrospective study was conduct to include trauma patients with Injury Severity Score(ISS) ≥16 between January 1 st , 2018 and December 31 st , 2019. Lymphocyte counts of each trauma patient were collected and recorded in first 3 hours, 6-12 hours, 24-48 hours, and 49-72 hours after trauma, separately. The degree of secondary on the trauma patients were evaluated according to the results of laboratory tests, the time stay in ICU and received mechanical ventilation, and 28-day outcome. Correlation analysis was performed between lymphocytes change and the score of the secondary tissue injury in severe trauma patients. Results: The lymphocyte count within first 3 hours after trauma was significantly high,the median was 4.03×10 9 /L, then dropped significantly in 6-72 hours after trauma (median: 0.85~0.99×10 9 /L), there was a significant statistical difference between the lymphocyte count within first 3 hours after trauma and that in 6-72 hours（P=0.000). The ratios of the lymphocytes counts in 6-72 hours to that within first 3 hours after trauma were very low, the median value was 0.22-0.27. The results of regression statistical analysis showed that the change of lymphocyte counts significantly associated with the severe degree of secondary injury (P=0.000). The lymphocyte ratio change can be used to predict the possibility of trauma patients secondary severe tissue injury occurred [Area Under the Curve( AUC) on the ratios of the lymphocytes counts in 6-72 hours to that within first 3 hours after trauma was 0.789, 0.840, 0.861, respectively]. The predictive thresholds of lymphocyte ratio of the trauma patients in the study were 0.31 to 0.35, the prediction sensitivity were 78% to 89% and specificity 74% to 84%. The lymphocyte counts there was significant difference between the patients with assessed as serious secondary tissue injury(87cases) and patients without(25 cases), the median value was 0.21-0.24 , 0.38-0.62, respectively , P=0.000. Conclusion: Lymphocytes counts was significantly increased in the trauma patients with ISS score ≥16 within the first 3 hours after trauma, then decreased significantly in 6-72 hours after trauma. The change of lymphocyte count was significant relationship with the degree of secondary tissue injury, that can be used to predict the degree of secondary severe tissue injury occurred by inflammatory reaction in trauma patients.

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Increased S-100 B levels are associated with fractures and soft tissue injury in multiple trauma patients

Injury ◽

10.1016/j.injury.2020.03.012 ◽

2020 ◽

Vol 51 (4) ◽

pp. 812-818

Author(s):

Martin Müller ◽

Julia M. Münster ◽

Wolf E. Hautz ◽

Joël L. Gerber ◽

Joerg C. Schefold ◽

...

Keyword(s):

Soft Tissue ◽

Multiple Trauma ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Trauma Patients ◽

S 100 ◽

Multiple Trauma Patients

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F.01 Prognostic factors in adults with spinal cord injury without radiological abnormalities (SCIWORA): MRI study

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.96 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S18-S19

Author(s):

R Martinez-Perez ◽

I Paredes ◽

J Cotrina ◽

S Pandey ◽

A Lagares

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Prognostic Factors ◽

Injury Severity ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Lesion Length ◽

Initial Examination ◽

Severity Of Injury ◽

Cord Injury

Background: Spinal Cord Injury Without Radiological Abnormality (SCIWORA) is underreported and poorly recognized in adults. This entity is an important subtype of spinal cord injury (SCI) with relatively good outcomes. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Methods: A retrospective review of adult patients with cervical SCI admitted to two University hospitals from January 2000 to December 2010 was performed. Only patients with an MRI performed within 72 hours after trauma were included. All patients with bony injury or traumatic malalignment were excluded. Data gathered on the remaining patients included demographics, mechanism of injury, severity of SCI, long-term patient outcome, improvement in neurological condition and MRI results. Results: 49 patients selected. Patients with extramedullary hemorrhage showed worse neurological status at initial examination. Disruption of either the anterior longitudinal ligament or ligamentum flavum was associated with worse outcomes at initial examination and at 1-year follow up. Lesion length was also significantly associated with outcomes at 1 year evaluation and initial evaluation. Conclusions: Early MRI has an important prognostic value in patients suffering SCIWORA. Lesion length is a powerful predictor of outcome. Soft tissue injury and spinal cord changes play a role in the severity of injury as well as the ability to recover.

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Venous Thromboembolism in Trauma Patients

The American Surgeon ◽

10.1177/000313480707301121 ◽

2007 ◽

Vol 73 (11) ◽

pp. 1173-1180 ◽

Cited By ~ 13

Author(s):

Om P. Sharma ◽

Michael F. Oswanski ◽

Rusin J. Joseph ◽

Peter Tonui ◽

Libby Westrick Pa-C ◽

...

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Univariate Analysis ◽

Trauma Patients ◽

Vein Thrombosis ◽

Cord Injury ◽

Deep Vein

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (≥6 RFs) VTE scores ( P = 0.172). Incidence was statistically different (3% vs 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (≥5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with ≥5 RFs vs <5RFs, obesity (14.3 vs 6.1%, P = 0.007), malignancy (5.6% vs 0.6%, P = 0.006), coagulopathy (10.8% vs 1.8%, P = 0.000), and previous VTE (3.2% vs 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score ( P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P ≤ 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of ≥15 and 25 had higher DVTs compared with the ones with lower injury severity score levels ( P ≤ 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.

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Massive Transfusion Protocol and Subsequent Development of Venous Thromboembolism: Statewide Analysis

The American Surgeon ◽

10.1177/0003134820948905 ◽

2020 ◽

pp. 000313482094890

Author(s):

Eric H. Bradburn ◽

Kwok M. Ho ◽

Madison E. Morgan ◽

Lauren D’Andrea ◽

Tawnya M. Vernon ◽

...

Keyword(s):

Venous Thromboembolism ◽

Injury Severity ◽

Massive Transfusion ◽

Subsequent Development ◽

Multivariate Logistic Regression Model ◽

Trauma Patients ◽

Vte Prophylaxis ◽

Vein Thrombosis ◽

Hemorrhagic Event ◽

High Index Of Suspicion

Background Massive transfusion protocols (MTP) are a routine component of any major trauma center’s armamentarium in the management of exsanguinating hemorrhages. Little is known about the potential complications of those that survive a MTP. We sought to determine the incidence of venous thromboembolism (VTE) following MTP. We hypothesized that MTP would be associated with a higher risk of VTE when compared with a risk-adjusted control population without MTP. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2015 to 2018 for trauma patients who developed VTE and survived until discharge at accredited trauma centers in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in VTE development between MTP and non-MTP patients. A multivariate logistic regression model assessed the adjusted impact of MTP on VTE development. Results 176 010 patients survived until discharge, meeting inclusion criteria. Of those, 1667 developed a VTE (pulmonary embolism [PE]: 662 [0.4%]; deep vein thrombosis [DVT]: 1142 [0.6%]; PE and DVT: 137 [0.1%]). 1268 patients (0.7%) received MTP and, of this subset of patients, 171 (13.5%) developed a VTE during admission. In adjusted analysis, patients who had a MTP and survived until discharge had a higher odds of developing a VTE (adjusted odds ratio: 2.62; 95% CI: 2.13-3.24; P < .001). Discussion MTP is a harbinger for higher risk of VTE in those patients who survive. This may, in part, be related to the overcorrection of coagulation deficits encountered in the hemorrhagic event. A high index of suspicion for the development of VTE as well as aggressive VTE prophylaxis is warranted in those patients who survive MTP.

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Post-Traumatic Sepsis Is Associated with Increased C5a and Decreased TAFI Levels

Journal of Clinical Medicine ◽

10.3390/jcm9041230 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1230 ◽

Cited By ~ 3

Author(s):

Jan Tilmann Vollrath ◽

Ingo Marzi ◽

Anna Herminghaus ◽

Thomas Lustenberger ◽

Borna Relja

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Area Under The Curve ◽

Statistical Correlation ◽

Sepsis Group ◽

Coagulation System ◽

Trauma Patients ◽

Inflammatory Factor ◽

Correlation Analyses ◽

Post Traumatic

Background: Sepsis frequently occurs after major trauma and is closely associated with dysregulations in the inflammatory/complement and coagulation system. Thrombin-activatable fibrinolysis inhibitor (TAFI) plays a dual role as an anti-fibrinolytic and anti-inflammatory factor by downregulating complement anaphylatoxin C5a. The purpose of this study was to investigate the association between TAFI and C5a levels and the development of post-traumatic sepsis. Furthermore, the predictive potential of both TAFI and C5a to indicate sepsis occurrence in polytraumatized patients was assessed. Methods: Upon admission to the emergency department (ED) and daily for the subsequent ten days, circulating levels of TAFI and C5a were determined in 48 severely injured trauma patients (injury severity score (ISS) ≥ 16). Frequency matching according to the ISS in septic vs. non-septic patients was performed. Trauma and physiologic characteristics, as well as outcomes, were assessed. Statistical correlation analyses and cut-off values for predicting sepsis were calculated. Results: Fourteen patients developed sepsis, while 34 patients did not show any signs of sepsis (no sepsis). Overall injury severity, as well as demographic parameters, were comparable between both groups (ISS: 25.78 ± 2.36 no sepsis vs. 23.46 ± 2.79 sepsis). Septic patients had significantly increased C5a levels (21.62 ± 3.14 vs. 13.40 ± 1.29 ng/mL; p < 0.05) and reduced TAFI levels upon admission to the ED (40,951 ± 5637 vs. 61,865 ± 4370 ng/mL; p < 0.05) compared to the no sepsis group. Negative correlations between TAFI and C5a (p = 0.0104) and TAFI and lactate (p = 0.0423) and positive correlations between C5a and lactate (p = 0.0173), as well as C5a and the respiratory rate (p = 0.0266), were found. In addition, correlation analyses of both TAFI and C5a with the sequential (sepsis-related) organ failure assessment (SOFA) score have confirmed their potential as early sepsis biomarkers. Cut-off values for predicting sepsis were 54,857 ng/mL for TAFI with an area under the curve (AUC) of 0.7550 (p = 0.032) and 17 ng/mL for C5a with an AUC of 0.7286 (p = 0.034). Conclusion: The development of sepsis is associated with early decreased TAFI and increased C5a levels after major trauma. Both elevated C5a and decreased TAFI may serve as promising predictive factors for the development of sepsis after polytrauma.

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The significance of the levels of fibrin/fibrinogen degradation products for predicting trauma severity

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918790657 ◽

2018 ◽

Vol 26 (3) ◽

pp. 143-150 ◽

Cited By ~ 1

Author(s):

Masato Murata ◽

Shuichi Hagiwara ◽

Makoto Aoki ◽

Jun Nakajima ◽

Kiyohiro Oshima

Keyword(s):

Injury Severity Score ◽

Emergency Room ◽

Severity Score ◽

Injury Severity ◽

Degradation Products ◽

Area Under The Curve ◽

Trauma Patients ◽

Fibrinogen Degradation Products ◽

Trauma Severity ◽

D Dimer

Background: On initial treatment in the emergency room, trauma patients should be assessed using simple clinical indicators that can be measured quickly. Objectives: The purpose of this study is to investigate the relationship between the injury severity score and blood test parameters measured on emergency room arrival in trauma patients. Methods: Trauma patients transferred to Gunma University Hospital between May 2013 and April 2014 were evaluated in this prospective, observational study. Blood samples were collected immediately on their arrival at our emergency room and their hematocrit, platelet, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation products, and D-dimer were measured. We evaluated the correlations between the injury severity score and those biomarkers, and examined whether the correlation varied according to the injury severity score value. We also evaluated the correlations between the biomarkers and the abbreviated injury scale values of six regions. Results: We analyzed 371 patients. Fibrin/fibrinogen degradation products and D-dimer showed the greatest coefficients of correlation with injury severity score (0.556 and 0.543, respectively). The area under the curve of the receiver operating characteristic was larger in patients with injury severity score ⩾ 9 than in those with injury severity score ⩾ 4; however, patients with injury severity score ⩾ 9 or ⩾16 showed no significant differences. The area under the curve of fibrin/fibrinogen degradation products was larger than that of D-dimer at all injury severity score values. The chest abbreviated injury scale had the strongest relationship with fibrin/fibrinogen degradation products. Conclusion: Fibrin/fibrinogen degradation products and D-dimer were positively correlated with injury severity score, and the relationships varied according to trauma severity. Chest trauma contributed most strongly to fibrin/fibrinogen degradation product elevation.

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Incidence and Outcomes of Critical Illness-Related Corticosteroid Insufficiency in Trauma Patients

The American Surgeon ◽

10.1177/000313481107700517 ◽

2011 ◽

Vol 77 (5) ◽

pp. 579-585

Author(s):

Mark L. Walker ◽

Phillip S. Owen ◽

Candace Sampson ◽

Janene Marshall ◽

Teresa Pounds ◽

...

Keyword(s):

Critical Illness ◽

Injury Severity ◽

Strong Predictor ◽

Trauma Patients ◽

Mortality And Morbidity ◽

Clinical Criteria ◽

Severity Scores ◽

Prolonged Duration ◽

Injured Patients ◽

Corticosteroid Insufficiency

The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in trauma is not fully defined. This study describes our trauma experience with hydrocortisone-treated patients experiencing CIRCI. We conducted a 5-year retrospective analysis from a Level II trauma center using biochemical and clinical criteria for adrenal insufficiency. Seventy patients met the inclusion criteria for CIRCI. There was a 34 per cent mortality rate despite therapy. Nonsurvivors were older with larger admission base deficits and experienced higher rates of sepsis, bacteremia, and pneumonia. Nonsurvivors had prolonged vent days (mean 53 ± 64 days) when compared with survivors (mean 30 ± 22 days; P = 0.029). Renal replacement therapy was a strong predictor of mortality. Spinal cord-injured patients had high Injury Severity Scores (mean 34 ± 18), elevated baseline Cortisol levels (mean 56 ± 84 vs 18 ± 14; P = 0.004), and required prolonged duration of steroid therapy (30 ± 52 vs 15 ± 15 days; P = 0.080) when compared with the nonspinal cord-injured group. Our data suggest that CIRCI in trauma is associated with significant mortality and morbidity even when patients are treated appropriately.

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Damage Control Resuscitation Protocol and the Management of Open Abdomens in Trauma Patients

The American Surgeon ◽

10.1177/000313481408000825 ◽

2014 ◽

Vol 80 (8) ◽

pp. 768-775 ◽

Cited By ~ 11

Author(s):

Matthew Bradley ◽

Samuel Galvagno ◽

Amit Dhanda ◽

Carlos Rodriguez ◽

Margaret Lauerman ◽

...

Keyword(s):

Logistic Regression ◽

Injury Severity ◽

Damage Control ◽

Fascial Closure ◽

Trauma Patients ◽

Damage Control Resuscitation ◽

Total Blood ◽

Independent Risk Factors ◽

Student’S T ◽

Admission Glasgow Coma Scale

Although the use of damage control laparotomy (DCL) is well established, the effect of damage control resuscitation (DCR) on the management of open abdomens is relatively poorly studied. The aim of the present study was to determine the predictors for failure to achieve primary fascial closure (PFC) after DCL in the setting of a massive transfusion (MT) and DCR. This is a retrospective review over a 12-year period of all patients that underwent MT and DCL. Patients who achieved PFC were compared with those who did not (NPFC). Student's t tests were used to compare the two groups. A multiple logistic regression model was performed to identify independent risk factors for failure to attain PFC. Of 174 patients, 101 achieved PFC. Mean (6 standard deviation) age was 35.6 ± 14.9 years for PFC and 36.3 ± 14.0 years for NPFC ( P = 0.75). Admission Glasgow Coma Scale score was 11.4 ± 4.6 for PFC and 10.6 ± 5.0 for NPFC ( P = 0.25). Initial lactate (7.3 ± 3.8 vs 7.7 ± 4.1, P = 0.50), hemoglobin (11.3 ± 1.9 vs 11.0 ± 2.2, P = 0.43), systolic blood pressure (108 ± 44 vs 107 ± 35, P = 0.82), Injury Severity Score (34 ± 14 vs 36 ± 15, P = 0.32), and abdominal Abbreviated Injury Score (3.6 ± 1.1 vs 3.9 ± 1.0, P = 0.13) were similar between the two groups. There was no difference in total blood products administered at 24 hours (46 ± 26 vs 49 ± 29 units, P = 0.45). Logistic regression identified increasing volume of crystalloid at 24 hours (odds ratio, 0.86; 95% confidence interval, 0.74 to 0.99; P = 0.047), earlier operative year (2.1; 1.52 to 2.91; P < 0.001), and increased number of procedures (0.32, 0.18 to 0.58; P < 0.001) as independent predictors for failure to obtain PFC. Injury severity is not associated with failure to achieve PFC, whereas administration of large-volume crystalloid resuscitation, increasing number procedures, and earlier year of DCL are independent predictors for failure to achieve PFC. Application of DCR to DCL techniques results in an improvement in ability to achieve PFC.

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