[Activity of factor VII in patients with isolated blunt traumatic brain injury: association with coagulopathy and progressive hemorrhagic injury].
OBJECTIVE
To explore the relationship of the activity of plasma FVII with isolated blunt traumatic brain injury and progressive hemorrhagic injury.


METHODS
Eight-one isolated traumatic brain patients with moderate-to-severe injury, aged ≥ 16 yrs, were recruited from August 2010 to December 2012. The plasma factor VII activity was measured after admission. On arrival at emergency department, blood samples were collected to analyze the parameters of activated partial thromboplastic time (aPTT), international normalized ratio (INR), platelet count and activity of factor VII. TBI-associated coagulopathy was defined as elevated international normalized ratio >1.2 or prolonged activated partial thromboplastic time >40 seconds or platelet count <120×10(9)/L at admission. Progressive hemorrhagic injury was present when follow-up computed tomography (CT) noted any increase in size or number of hemorrhagic lesions. Logistic regression examined the risks for coagulopathy and progressive hemorrhagic injury after isolated traumatic brain injury.


RESULTS
FVII activity in patients with coagulopathy was 86% ± 35%. And it was significantly lower than those without coagulopathy (100 ± 29%, P < 0.05). Isolated traumatic brain injury patients with FVII activity <77.5% had an odds ratio for coagulopathy of 5.52 (95% confidence interval 1.82-16.68, P < 0.05) relative to those with FVII activity ≥ 77.5%. FVII activity in patients with progressive hemorrhagic injury was 71% ± 18%. And it was significantly lower than those without progressive hemorrhagic injury (106% ± 32%, P < 0.001). Stepwise Logistic regression analysis identified FVII < 77.5% as a predisposing risk factor independently associated with the presence of progressive hemorrhagic injury. The overall mortality rate in the surveyed population was 7.4% (6/81). The plasma FVII in deceased patients (91% ± 47%) was slightly lower than that in survivors (92% ± 32%, P > 0.05). No significant difference existed between two groups (P > 0.05).


CONCLUSIONS
Decreased activity of FVII is closely correlated with coagulopathy in patients with isolated blunt traumatic brain injury. And coagulopathy and decreased FVII activity are predisposing risk factors independently associated with progressive hemorrhagic injury.
Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou 450003, China. Email: dunawe@yahoo.com.cn.
Chaoyue
C
Li
Bingbing
B
Pei
Xing
X
Wu
Xin
X
Lu
Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University. Email: hujin_dana@126.com.
Jin
J
Hu
Liangfu
L
Zhou
D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001930:Brain Injuries / Q000097:blood* / Q000150:complications; D005167:Factor VII / Q000378:metabolism*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D005167:Factor VII