Individual clotting factor contributions to mortality following trauma

Area of Science:

• Trauma and Emergency Medicine
• Hematology
• Coagulation Science

Background:

• Acute traumatic coagulopathy impacts 20-30% of trauma patients.
• The complexity of the coagulation cascade hinders understanding of global clotting factor dysfunction.
• This study aimed to define clotting factor dysfunction phenotypes and their impact on trauma mortality.

Purpose of the Study:

• To characterize distinct phenotypes of clotting factor dysfunction in major trauma patients.
• To determine the contribution of these phenotypes to 28-day mortality.
• To explore the potential for personalized hemostatic resuscitation based on identified phenotypes.

Main Methods:

• A prospective cohort study of adult trauma patients (highest activation level) from 2005-2015.
• Assessment of coagulation factors (II, V, VII, VIII, IX, X) and protein C activity on admission.
• Principal component analysis to identify coagulation phenotypes and logistic regression to predict mortality, controlling for TBI, acidosis, age, and injury mechanism.

Main Results:

• Two significant principal components (phenotypes) explained 66.3% of variance in coagulation abnormalities.
• Phenotype 1 (factors II, VII, IX, X, protein C) was linked to increased injury, coagulopathy, TBI, and mortality.
• Phenotype 2 (factors V, VIII) was associated with increased coagulopathy and mortality, and remained the sole significant predictor of 28-day mortality in regression analysis.

Conclusions:

• Two distinct global clotting factor abnormality phenotypes were identified in trauma patients.
• Findings highlight the critical association of factors V and VIII with trauma-related mortality.
• This research represents a potential first step towards personalized hemostatic resuscitation strategies in trauma care.