Risk Factors for Trauma-Induced Coagulopathy- and Transfusion-Associated Multiple Organ Failure in Severely Injured Trauma Patients

Abstract

BackgroundBoth trauma-induced coagulopathy (TIC) and transfusion strategies influence early outcome in hemorrhagic trauma patients. Their impact on late outcome is less well characterized. This study systematically reviews risk factors for TIC- and transfusion-associated multiple organ failure (MOF) in severely injured trauma patients.Materials and methodsA systematic search was conducted in PubMed and Embase. Studies published from 1986 to 2013 on adult trauma patients with an injury severity score ≥16, investigating TIC or transfusion strategies with MOF as primary or secondary outcome, were eligible for inclusion. Results of the included studies were evaluated with meta-analyses of pooled data.ResultsIn total, 50 studies were included with a total sample size of 63,586 patients. Due to heterogeneity of the study populations and outcome measures, results from 7 studies allowed for pooling of data. Risk factors for TIC-associated MOF were hypocoagulopathy, hemorrhagic shock, activated protein C, increased histone levels, and increased levels of markers of fibrinolysis on admission. After at least 24 h after admission, the occurrence of thromboembolic events was associated with MOF. Risk factors for transfusion-associated MOF were the administration of fluids and red blood cell units within 24 h post-injury, the age of red blood cells (>14 days) and a ratio of FFP:RBC ≥ 1:1 (OR 1.11, 95% CI 1.04–1.19).ConclusionRisk factors for TIC-associated MOF in severely injured trauma patients are early hypocoagulopathy and hemorrhagic shock, while a hypercoagulable state with the occurrence of thromboembolic events later in the course of trauma predisposes to MOF. Risk factors for transfusion-associated MOF include administration of crystalloids and red blood cells and a prolonged storage time of red blood cells. Future prospective studies investigating TIC- and transfusion-associated risk factors on late outcome are required.

Supernatants and lipids from stored red blood cells activate pulmonary microvascular endothelium through the BLT2 receptor and protein kinase C activation

“…45 In addition, numerous investigators have concluded that the resuscitation of injured patients with older, stored RBC units may result in increased mortality, infections, ALI or ARDS, and postinjury MOF, and such clinical complications may be due to the numbers of units transfused and the "dose" of proinflammatory agents in the stored RBCs. 6,10,11,14,[46][47][48][49][50][51][52][53][54][55][56][57] The presented in vitro and in vivo studies of proinflammatory activation of HMVECs by stored RBCs or LR-RBCs support these observations, and it is important to note that such activation only occurred with the transfusion of ">4," ">8," and ">16" units of RBCs, depending on the weight of the patient and their inherent plasma volume, analogous to the final concentration of 10% to 40% of D42 LR-RBC supernatant. These lipids increase during routine storage and large to massive transfusions may allow for exposure to large concentrations of LR-RBC supernatants and the NLs that they contain.…”

Washing or filtering of blood products does not improve outcome in a rat model of trauma and multiple transfusion

“…Balanced resuscitation with blood products in ratios similar to whole blood is the mainstay to treat trauma‐induced coagulopathy and prevent exsanguination. However, transfusion is associated with adverse effects, including multiple organ failure (MOF) and nosocomial infection . The mechanisms by which transfusion exerts these effects probably include modulation of the host coagulation and immune response.…”

“…The mechanisms by which transfusion exerts these effects probably include modulation of the host coagulation and immune response. Several studies showed an association between trauma‐induced coagulopathy and the development of MOF . Also, following trauma, both pro‐ and anti‐inflammatory profiles have been reported .…”

Hemodynamics and Oxygen Metabolism Changes in Different Types of Fluid Resuscitation in Multiple Trauma

“…При цьому в структурі смертності від політравми СПОН займає до 37,5% [21]. Факторами ризику його розвитку є рання травматична коагулопатія, геморагічний шок, введення кристалоїдів та ерит-ромаси [7].Рестриктивна стратегія передбачає зниження об'єму ІТ. Сьогодні вона перебуває в стадії актив-ної розробки і не має чітко доведених доз, обсягу, складу препаратів, проте її переваги вже не викли-кають сумнівів [2].…”

“…При цьому в структурі смертності від політравми СПОН займає до 37,5% [21]. Факторами ризику його розвитку є рання травматична коагулопатія, геморагічний шок, введення кристалоїдів та ерит-ромаси [7].…”