Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited.
BACKGROUND
Recalcitrant coagulopathy "the bloody vicious cycle," produces the majority of deaths after torso trauma. A model predicting this life-threatening complication may facilitate clinical decision-making.


METHODS
We prospectively analyzed patients > 15 years old who received a massive transfusion (> 10 units of packed red blood cells (PRBC)/24 h) over a 2-year period. Excluding massive head injuries and pre-existing disease, the 58 study patients had a mean age = 35.4 years, Injury Severity Score (ISS) = 30.6, and PRBC = 24.2 units/24 h.


RESULTS
Defined as prothrombin time of two times that of normal laboratory controls and partial thromboplastin time as two times that of normal laboratory controls, 27 patients (47%) developed life-threatening coagulopathy. Using a multiple logistic regression model, the four significant risk factors (with odds ratio) were (1) pH < 7.10 (12.3), (2) temperature < 34 degrees C (8.7), (3) ISS > 25 (7.7), and (4) systolic blood pressure < 70 mm Hg (5.8). The conditional probability of developing coagulopathy was ISS > 25 + systolic blood pressure < 70 mm Hg = 39%, ISS > 25 + temperature < 34 degrees C = 49%, ISS > 25 + pH < 7.10 = 49%; with all four risk factors the incidence was 98%.


CONCLUSIONS
Postinjury life-threatening coagulopathy in the seriously injured requiring massive transfusion is predicted by persistent hypothermia and progressive metabolic acidosis.
Cosgriff
N
N
Department of Surgery, Denver Health Medical Center, Colorado 80204, USA.
Moore
E E
EE
Sauaia
A
A
Kenny-Moynihan
M
M
Burch
J M
JM
Galloway
B
B
D000007:Abdominal Injuries / Q000150:complications / Q000628:therapy*; D000138:Acidosis / Q000209:etiology*; D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology*; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000150:complications / Q000628:therapy*; D065227:Transfusion Reaction