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Published on: November 20, 2016
High circulating adrenaline levels at admission predict increased mortality after trauma
Pär Ingemar Johansson1, Jakob Stensballe, Lars Simon Rasmussen
1Section forTransfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark. per.johansson@rh.regionh.dk
The Journal of Trauma and Acute Care Surgery
|March 24, 2012
Summary
Trauma-induced catecholamine surges are linked to coagulopathy and poor outcomes. This study found adrenaline levels correlate with tissue damage and predict mortality in trauma patients.
Area of Science:
- Traumatology
- Hemostasis
- Critical Care Medicine
Background:
- Trauma-induced acute coagulopathy is a significant predictor of poor patient outcomes.
- The exact pathophysiology remains unclear, with severe injury and shock implicated as primary drivers.
- This study explores the connection between sympathoadrenal activation (elevated catecholamines) and coagulopathy markers.
Purpose of the Study:
- To investigate the association between circulating catecholamines and biomarkers of coagulopathy in trauma patients.
- To determine if sympathoadrenal activation is linked to endothelial damage, glycocalyx degradation, and hyperfibrinolysis.
- To identify predictors of 30-day mortality in trauma patients.
Main Methods:
- Prospective study of 75 adult trauma patients admitted to a Level I trauma center.
- Patients categorized by Injury Severity Score (ISS) and blood samples analyzed on arrival.
- Measured coagulation parameters, hematology, biochemistry, adrenaline, noradrenaline, and 11 biomarkers of endothelial damage, glycocalyx degradation, anticoagulation, and fibrinolysis.
Main Results:
- Nonsurvivors exhibited higher adrenaline levels, independently associated with increased activated partial thromboplastin time and syndecan-1 (a marker of glycocalyx degradation).
- Adrenaline correlated with biomarkers of tissue/endothelial damage and hyperfibrinolysis, including D-dimer.
- Elevated syndecan-1, tissue factor pathway inhibitor, and D-dimer were observed in nonsurvivors. Adrenaline, age, and severe head injury independently predicted 30-day mortality.
Conclusions:
- The surge in catecholamines following trauma is closely linked to endothelial damage, glycocalyx degradation, and coagulopathy, including hyperfibrinolysis.
- Circulating adrenaline is an independent predictor of mortality in trauma patients.
- These findings highlight the role of sympathoadrenal activation in the adverse outcomes associated with severe trauma.
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