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Microfluidics in Assessing Platelet Function
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Principal component analysis of coagulation assays in severely injured children

Christine M Leeper1, Matthew D Neal2, Christine McKenna3

  • 1Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.

Surgery
|December 18, 2017
PubMed

Insights

Trauma-induced coagulopathy in children presents three distinct patterns: clot strength, fibrinolysis, and clotting factor depletion. Fibrinolysis abnormalities are linked to severe injury and worse outcomes, including VTE and disability.

Area of Science:

  • Pediatric critical care
  • Trauma surgery
  • Hematology

Background:

  • Trauma-induced coagulopathy is a frequent complication in pediatric trauma patients.
  • Coagulopathy is associated with increased mortality and morbidity in injured children.

Purpose of the Study:

  • To identify distinct patterns (phenotypes) of coagulation dysregulation in children following severe trauma.
  • To associate these identified coagulation phenotypes with clinical outcomes such as mortality, disability, and need for blood transfusion.

Main Methods:

  • Principal component analysis (PCA) was applied to prospectively collected data from pediatric trauma patients.
  • Coagulation parameters including international normalized ratio, platelet count, and thromboelastography variables were analyzed.
  • PCA identified key components representing coagulation patterns, which were then used in logistic regression to assess associations with clinical outcomes.

Main Results:

  • Three significant principal components explained 75% of the variance in coagulation parameters.
  • These components represented clot strength, abnormal fibrinolysis (hyperfibrinolysis or shutdown), and global clotting factor depletion.
  • All three patterns were associated with increased mortality and blood transfusion requirements.
  • Abnormal fibrinolysis was significantly correlated with injury severity and predicted venous thromboembolism and functional disability.

Conclusions:

  • PCA effectively identifies three distinct patterns of coagulation dysregulation in pediatric trauma using standard laboratory tests.
  • While clot strength and factor depletion are linked to adverse outcomes, abnormal fibrinolysis is particularly associated with severe injury and portends a worse prognosis, including higher risks of VTE and disability.
Abstract

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