title: Time course of soluble P-selectin and von Willebrand factor levels in trauma patients: a prospective observational study.
abstract: BACKGROUND
  Coagulopathy often develops in patients with serious trauma and is correlated with the clinical outcome. The contribution of platelet activity and endothelial dysfunction to trauma-induced coagulopathy remain to be defined. The purpose of this study was to investigate the time courses of soluble P-selectin (sPsel, an index of platelet activation) and von Willebrand factor (VWF, an index of endothelial dysfunction) in trauma patients and elucidate their relationship to coagulation parameter levels, the presence of coagulopathy, and patient outcome.
  
  
  METHODS
  This prospective observational study, which took place in a university hospital intensive care unit (ICU), included 82 severely injured trauma patients. The sPsel, VWF antigen, protein C, and factor VII levels were measured and routine coagulation tests were performed upon admission to ICU and daily within the first week. The 30-day mortality rate was also determined.
  
  
  RESULTS
  Thirty-seven (45.1%) patients developed coagulopathy upon admission to the ICU, and the 30-day mortality rate was 20.7% (n = 17). Both the admission sPsel and VWF levels were lower in patients with coagulopathy than in those without (p < 0.05) and were significantly correlated with the protein C and factor VII levels, respectively (all p < 0.05). The VWF levels were lower during the first 3 days and higher on day 7 after admission in nonsurvivors than in survivors (all p < 0.05). No significant differences in sPsel levels were found between nonsurvivors and survivors on each day during the first week.
  
  
  CONCLUSIONS
  In severely injured trauma patients in the ICU, lower levels of sPsel and VWF on admission were associated with the presence of coagulopathy and might not predict a better outcome. An increase in the VWF level at the end of the first week after admission to ICU was associated with increased 30-day mortality.
authors.affiliation: Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China. indicator2001@sina.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Tang
authors.forename: Shiyu
authors.initials: S
authors.lastname: Yin
authors.forename: Ziyong
authors.initials: Z
authors.lastname: Sun
authors.forename: Yingying
authors.initials: Y
authors.lastname: Pan
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D002681:China / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood*; D011446:Prospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications / Q000401:mortality; D014841:von Willebrand Factor / Q000032:analysis* / Q000378:metabolism
chemical_list: D019007:P-Selectin; D014841:von Willebrand Factor
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