title: Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM) is associated with higher mortality in patients with severe trauma.
abstract: BACKGROUND
  We investigated whether hyperfibrinolysis and its severity was associated with outcome of traumatized and nontraumatized patients.
  
  
  METHODS
  From April 2008 to April 2010, all emergency patients with hyperfibrinolysis were enrolled in this study. Hyperfibrinolysis patients were divided into traumatized (trauma hyperfibrinolysis group) and nontraumatized (nontrauma hyperfibrinolysis group). The trauma hyperfibrinolysis group was matched with 24 polytrauma patients without hyperfibrinolysis (matched trauma group). Data from rotational thromboelastometry measurements, blood gas analysis (metabolic state), laboratory analysis, injury severity score, and 30-day mortality were collected.
  
  
  RESULTS
  Thirty-five patients with hyperfibrinolysis were identified (13 traumatized, 22 nontraumatized). Overall mortality for hyperfibrinolysis was 54%. Mortality in the trauma hyperfibrinolysis group (77%±12%) was significantly higher than in the nontrauma hyperfibrinolysis group (41%±10%; P=0.001, 95% CI 5%-67%) and the matched trauma group (33%±10%; P=0.009, 95% CI 13%-74%). Hyperfibrinolysis is significantly (P=0.017) associated with mortality in trauma patients. In the blood gas analysis representing the metabolic state, only pH (P=0.02) and potassium (P=0.01) were significantly lower in the trauma hyperfibrinolysis group compared to the nontrauma hyperfibrinolysis group.
  
  
  CONCLUSIONS
  Mortality from hyperfibrinolysis is significantly higher in trauma compared with nontrauma patients, and hyperfibrinolysis is an independent factor predicting mortality in trauma patients. Rotational thromboelastometry provides real-time recognition of hyperfibrinolysis allowing early treatment.
authors.affiliation: Institute of Anesthesiology, Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, and Institute of Sockal and Preventive Medicine, University of Zurich, CH-8091 Zurich, Switzerland. oliver.theusinger@usz.ch
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.forename: Maximilian Y
authors.initials: MY
authors.lastname: Emmert
authors.forename: Adrian
authors.initials: A
authors.lastname: Billeter
authors.forename: Jennifer
authors.initials: J
authors.lastname: Eismon
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Werner
authors.initials: W
authors.lastname: Baulig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D001784:Blood Gas Analysis; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D013916:Thrombelastography / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D055815:Young Adult