International normalized ratio as a predictor of mortality in trauma patients in India

Hemorrhage is the second leading cause of death in trauma patients preceded only by traumatic brain injury. But hemorrhagic shock is the most common cause of preventable death within 6 hours of admission. Traumatic coagulopathy is a hypocoagulable state that occurs in the most severely injured. International normalized ratio (INR) and its relationship with trauma mortality have not been studied specifically. This study aimed to establish a predictive value of INR for trauma-related mortality.

A total of 99 trauma patients aged 18-70 years were included in the study. Their INR was determined and patient progression was followed up till death/discharge. According to previous retrospective studies, the cutoff value for INR in our study was kept at 1.5.

The total mortality rate of the patients was 16.16% (16/99). The mean INR was 1.45 with a SD of 1.35. INR was deranged in a total of 14 patients (14.14%). Of these patients, 11 died (78.57%) and 3 survived. INR was deranged in 11 (68.75%) of the 16 patients who died, but 5 deaths (31.25%) had normal INR values. The sensitivity of INR was 69% (95%CI 41%-88%) and the specificity 96% (95%CI 90%-99%). The diagnostic accuracy of INR was 92% (95%CI 85%-96%). Positive predictive value and negative predictive value were 79% (95%CI 49%-95%) and 94% (95%CI 87%-98%), respectively.

Our results showed that INR is a good predictor of mortality in trauma patients.