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Balvers K, Wirtz MR, van Dieren S, et al. Risk factors for trauma-induced coagulopathy- and transfusion-associated multiple organ failure in severely injured trauma patients. Front Med (Lausanne). 2015;2:24doi: 10.3389/fmed.2015.00024.
Balvers, K., Wirtz, M. R., van Dieren, S., Goslings, J. C., & Juffermans, N. P. (2015). Risk factors for trauma-induced coagulopathy- and transfusion-associated multiple organ failure in severely injured trauma patients. Frontiers in medicine, 224. https://doi.org/10.3389/fmed.2015.00024
Balvers, Kirsten, et al. "Risk factors for trauma-induced coagulopathy- and transfusion-associated multiple organ failure in severely injured trauma patients." Frontiers in medicine vol. 2 (2015): 24. doi: https://doi.org/10.3389/fmed.2015.00024
Balvers K, Wirtz MR, van Dieren S, Goslings JC, Juffermans NP. Risk factors for trauma-induced coagulopathy- and transfusion-associated multiple organ failure in severely injured trauma patients. Front Med (Lausanne). 2015 Apr 24;2:24. doi: 10.3389/fmed.2015.00024. eCollection 2015. PMID: 25964951; PMCID: PMC4408845.
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Front Med (Lausanne). 2015 Apr 24;2:24. doi: 10.3389/fmed.2015.00024. eCollection 2015.

Risk factors for trauma-induced coagulopathy- and transfusion-associated multiple organ failure in severely injured trauma patients.

Frontiers in medicine

Kirsten Balvers, Mathijs R Wirtz, Susan van Dieren, J Carel Goslings, Nicole P Juffermans

Affiliations

  1. Trauma Unit, Department of Surgery, Academic Medical Center , Amsterdam , Netherlands ; Department of Intensive Care, Academic Medical Center , Amsterdam , Netherlands.
  2. Clinical Research Unit, Academic Medical Center , Amsterdam , Netherlands.
  3. Trauma Unit, Department of Surgery, Academic Medical Center , Amsterdam , Netherlands.
  4. Department of Intensive Care, Academic Medical Center , Amsterdam , Netherlands.

PMID: 25964951 PMCID: PMC4408845 DOI: 10.3389/fmed.2015.00024

Abstract

BACKGROUND: Both trauma-induced coagulopathy (TIC) and transfusion strategies influence early outcome in hemorrhagic trauma patients. Their impact on late outcome is less well characterized. This study systematically reviews risk factors for TIC- and transfusion-associated multiple organ failure (MOF) in severely injured trauma patients.

MATERIALS AND METHODS: A systematic search was conducted in PubMed and Embase. Studies published from 1986 to 2013 on adult trauma patients with an injury severity score ≥16, investigating TIC or transfusion strategies with MOF as primary or secondary outcome, were eligible for inclusion. Results of the included studies were evaluated with meta-analyses of pooled data.

RESULTS: In total, 50 studies were included with a total sample size of 63,586 patients. Due to heterogeneity of the study populations and outcome measures, results from 7 studies allowed for pooling of data. Risk factors for TIC-associated MOF were hypocoagulopathy, hemorrhagic shock, activated protein C, increased histone levels, and increased levels of markers of fibrinolysis on admission. After at least 24 h after admission, the occurrence of thromboembolic events was associated with MOF. Risk factors for transfusion-associated MOF were the administration of fluids and red blood cell units within 24 h post-injury, the age of red blood cells (>14 days) and a ratio of FFP:RBC ≥ 1:1 (OR 1.11, 95% CI 1.04-1.19).

CONCLUSION: Risk factors for TIC-associated MOF in severely injured trauma patients are early hypocoagulopathy and hemorrhagic shock, while a hypercoagulable state with the occurrence of thromboembolic events later in the course of trauma predisposes to MOF. Risk factors for transfusion-associated MOF include administration of crystalloids and red blood cells and a prolonged storage time of red blood cells. Future prospective studies investigating TIC- and transfusion-associated risk factors on late outcome are required.

Keywords: coagulopathy; multiple organ failure; resuscitation; transfusion; trauma

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