title: The influence of hemocoagulation disorders on the development of posttraumatic cerebral infarction and outcome in patients with moderate or severe head trauma.
abstract: Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065-4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090-7.648), D-dimer (>2 mg/L) (OR 7.260, 95% CI 1.822-28.076), or disseminated intravascular coagulation (DIC) scores (≥ 5) (OR 4.717, 95% CI 1.778-12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2 mg/L) and DIC scores (≥ 5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.
authors.affiliation: Department of Neurosurgery, Shanghai 6th People Hospital, Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Li-Xia
authors.initials: LX
authors.lastname: Xue
authors.forename: Yan
authors.initials: Y
authors.lastname: Guo
authors.forename: Shi-Wen
authors.initials: SW
authors.lastname: Chen
authors.forename: Gan
authors.initials: G
authors.lastname: Wang
authors.forename: He-Li
authors.initials: HL
authors.lastname: Cao
authors.forename: Jiong
authors.initials: J
authors.lastname: Chen
authors.forename: Heng-Li
authors.initials: HL
authors.lastname: Tian
mesh_terms: D000293:Adolescent; D000328:Adult; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000209:etiology*; D003710:Demography; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult