title: Occurrence and recurrence of spontaneous chronic subdural haematoma is associated with a factor XIII deficiency.
abstract: OBJECTIVE
  In some patients, chronic subdural haematoma (cSDH) appears to occur spontaneously with frequent re-bleeding events. The pathophysiology of this phenomenon is still poorly understood. Because coagulation factor XIII (FXIII) is known to be involved in vascular integrity, endothelial barrier function and wound healing, we evaluated the role of FXIII in spontaneous cSDH.
  
  
  METHODS
  We prospectively scrutinised the origin of cSDH in 117 patients and identified a subgroup of patients suffering from spontaneous cSDH who were included in this study. We analysed the plasma activity of FXIII and standard coagulation parameters and compared these data to age- and sex-matched healthy controls. We assessed the occurrence of re-bleeding events using clinical and imaging data and compared FXIII activity in patients with and without re-bleeding events.
  
  
  RESULTS
  Out of 117 cSDH patients, 18 individuals suffered from spontaneous cSDH in this study. The patients with spontaneous cSDH showed significantly lower FXIII activity than the control group (65% [52.75, 80.25] (median [IQR]) vs. 93% [81, 111], P=0.001), whereas standard coagulation parameters did not differ significantly between the groups. Six patients developed re-bleeding events after haematoma evacuation, and these patients expressed significantly lower FXIII activity compared to the other 12 patients (47.5% [33.5, 64] vs. 78.5% [58, 87], P=0.005). The patient group with FXIII≤68.5% differed significantly from the group with FXIII>68.5% when categorised by the occurrence of re-bleeding events (n=6/9 vs. n=0/9, P=0.009). This cut-off value predicted the re-bleeding events with a sensitivity of 100% and a specificity of 75% (positive predictive value: 66%, negative predictive value: 100%).
  
  
  CONCLUSIONS
  FXIII deficiency may play a pathophysiological role in spontaneous cSDH, so we suggest investigating FXIII activity because it may predict re-bleeding events after treatment. In individuals with considerably low FXIII activity, FXIII substitution may mitigate the chronic nature of this disease.
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Germany. bert.bosche@gmail.com
authors.forename: Bert
authors.initials: B
authors.lastname: Bosche
authors.forename: Marek
authors.initials: M
authors.lastname: Molcanyi
authors.forename: Thomas
authors.initials: T
authors.lastname: Noll
authors.forename: Matthias
authors.initials: M
authors.lastname: Kochanek
authors.forename: Bastian
authors.initials: B
authors.lastname: Kraus
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rieger
authors.forename: Faycal
authors.initials: F
authors.lastname: El Majdoub
authors.forename: Christian
authors.initials: C
authors.lastname: Dohmen
authors.forename: Mario
authors.initials: M
authors.lastname: Löhr
authors.forename: Roland
authors.initials: R
authors.lastname: Goldbrunner
authors.forename: Gerrit
authors.initials: G
authors.lastname: Brinker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology; D005176:Factor XIII / Q000096:biosynthesis; D005177:Factor XIII Deficiency / Q000150:complications* / Q000503:physiopathology; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D005176:Factor XIII