Analysis Of Risk Factors And Prognosis In Patients With Hyperfibrinolysis After Severe Trauma

Objective:Post-traumatic hyperfibrinolysis was closely related to the poor prognosis of patients.Extensive studies with large-sample sizes have confirmed that early-stage empirical antifibrinolytic therapy contribute to the extension of survival rates.In this study,thrombelastograghy(TEG)was utilized for the diagnosis of hyperfibrinolysis,followed by observation of the incidence of hyperfibrinolysis in the patients with severe trauma.Meanwhile,the clinical characteristics and prognosis of these patients were analyzed,which can provide more evidence for the early-stage empirical antifibrinolytic therapyMethod:Between October 2017 and December 2018,we prospectively included severe trauma patients admitted to the ICU of the First People's Hospital of Taicang City.All the patients were diagnosed with hyperfibrinolysis based on the LY30 of?3%,and then the general information,routine blood examination,blood coagulation function,and TEG findings were collected from each patient.Uni-variate and multi-variate Logistic regression analysis were used to identify the risk factors for the pathogenesis of hyperfibrinolysis after severe trauma.Moreover,the incidence of massive transfusion and multiple organ dysfunction syndrome(MODS)was analyzed,together with analyzing the prognostic indicators of the patientsResults:In total,142 severe trauma patients were included in this study,among which 21(14.8%)were diagnosed with hyperfibrinolysis.Risk factors with statistical differences in the uni-variate analysis were entered in the multi-variate Logistic regression analysis.Blood platelet count(OR=1.035,95%CI=1.011-1.059,P=0.004),Injury Severe Score(ISS)(OR=0.898,95%CI=0.823-0.980,P=0.016)and lactate level(OR=0.735,95%CI=0.547-0.987,P=0.041)were independent risk factors for the hyperfibrinolysis after severe trauma.Massive transfusion was required more in hyperfibrinolysis group(38.1%vs.2.5%P<0.01),and the incidence of MODS was significantly higher(90.5%vs.48.8%,P<0.01)together with higher 24-h mortality(47.6%vs.8.3%,P<0.01)compared with those without hyperfibrinolysis.Major bleeding was mainly responsible for such phenomenon(66.7%).K-M survival curve indicated that the median survival time of hyperfibrinolysis after trauma was 1.33 days(IQR,0.40-17.20 days).Conclusions:The incidence of hyperfibrinolysis after severe trauma in this study was 14.8%.Blood platelet count,lactate level and ISS score were independent risk factors for it The patients with hyperfibrinolysis after severe trauma should receive massive transfusion,and the incidence of MODS was high together with a higher mortality in the early-stage.