Abstract:

Objective To explore the role of changes in coagulation function in predicting short-term prognosis in patients with severe traumatic brain injury (sTBI).

Methods Clinical data of 329 sTBI patients were retrospectively collected and analyzed. According to the prognosis at discharge, the patients were divided into poor prognosis group(n=139) and good prognosis group(n=190). Coagulation function indexes at admission were collected from the two groups, and the influence of coagulation function indexes on patients′ prognosis was evaluated by multivariate Logistic analysis.

Results  The incidence of coagulation dysfunction in the poor prognosis group was higher than that in the good prognosis group, while the fibrinogen(Fib) was lower than that in the good prognosis group; the proportion of midline shift＞5 mm on admission, double negative pupil response to light, and acute surgery was higher than that in the good prognosis group(P＜0.05). Activated partial thromboplastin time(APTT) and prothrombin time(PT) were longer than those in the good prognosis group(P＜0.05). Multivariate Logistic regression analysis showed that PT＞14.6 s(OR=1.66, 95%CI: 1.23-4.12, P=0.006), and APTT＞39.3 s(OR=1.38, 95%CI: 1.15-2.97, P=0.010) were independent risk factors for poor prognosis in patients with sTBI, and Fib＞2.7 g/L(OR=0.79, 95%CI: 0.32-0.89, P=0.024) was its protective factor. The ROC curve showed that the AUC［0.843(95%CI:0.783-0.902, P＜0.001)］ for PT to predict poor prognosis of sTBI patients was higher than Fib［0.735(95%CI:0.658-0.811, P＜0.001)］ and APTT［ 0.762(95%CI: 0.691-0.833, P＜0.001)］.

Conclusion sTBI patients with coagulation dysfunction are more common. PT and APTT are prolonged, while Fib is reduced. The short-term mortality risk of patients is increased, and PT has the highest predictive value.

Key words: craniocerebral trauma, coagulation function, prognosis