Early Fibrinolysis Associated with Hemorrhagic Progression Following Traumatic Brain Injury

Area of Science:

• Trauma research
• Neurocritical care
• Biomarker discovery

Background:

• Progressive hemorrhagic injury (PHI) is a frequent complication in severe traumatic brain injury (TBI).
• The pathophysiology of PHI is not well understood and difficult to predict.
• Identifying predictive markers for PHI is crucial for improving patient outcomes.

Purpose of the Study:

• To explore potential predictive markers for PHI in patients with severe TBI.
• To investigate the association of fibrinolysis markers with PHI development.
• To establish the predictive value of identified markers in PHI following TBI.

Main Methods:

• Retrospective chart review of prospectively collected data from 424 trauma patients.
• Inclusion criteria: severe TBI (AIS score ≥3) with intracranial hemorrhage (ICH) on initial CT.
• Measurement of plasminogen, uPA, tPA, PAI-1, α2AP, and DD levels at multiple time points; PHI defined by ICH expansion on repeat CT.

Main Results:

• Longitudinal models indicated tPA and DD were positively associated with PHI, while α2AP was inversely associated.
• Elevated DD levels showed a strong association with the development of PHI over time.
• Receiver operating curve analysis identified an admission DD cutoff of 3.04 μg/mL to differentiate SH from PHI patients.

Conclusions:

• Findings suggest a link between fibrinolysis markers and PHI in severe TBI patients.
• Further research is warranted to explore novel predictive biomarkers for PHI.
• This study highlights the potential of DD as an early indicator of PHI.