title: Early hemostatic responses to trauma identified with hierarchical clustering analysis.
abstract: BACKGROUND
  Trauma-induced coagulopathy is a complex multifactorial hemostatic response that is poorly understood.
  
  
  OBJECTIVE
  To identify distinct hemostatic responses to trauma and identify key components of the hemostatic system that vary between responses.
  
  
  METHODS
  A cross-sectional observational study of adult trauma patients at an urban level I trauma center emergency department was performed. Hierarchical clustering analysis was used to identify distinct clusters of similar subjects according to vital signs, injury/shock severity, and comprehensive assessment of coagulation, clot formation, platelet function, and thrombin generation.
  
  
  RESULTS
  Among 84 total trauma patients included in the model, three distinct trauma clusters were identified. Cluster 1 (N = 57) showed platelet activation, preserved peak thrombin generation, plasma coagulation dysfunction, a moderately decreased fibrinogen concentration and normal clot formation relative to healthy controls. Cluster 2 (N = 18) showed platelet activation, preserved peak thrombin generation, and a preserved fibrinogen concentration with normal clot formation. Cluster 3 (N = 9) was the most severely injured and shocked, and showed a strong inflammatory and bleeding phenotype. Platelet dysfunction, thrombin inhibition, plasma coagulation dysfunction and a decreased fibrinogen concentration were present in this cluster. Fibrinolytic activation was present in all clusters, but was particularly increased in cluster 3. Trauma clusters were most noticeably different in their relative fibrinogen concentration, peak thrombin generation, and platelet-induced clot contraction.
  
  
  CONCLUSIONS
  Hierarchical clustering analysis identified three distinct hemostatic responses to trauma. Further insights into the underlying hemostatic mechanisms responsible for these responses are needed.
authors: Department of Medicine/Division of Emergency Medicine, University of Washington, and Puget Sound Blood Center Research Institute, Seattle, WA, USA.
authors: N J
authors: NJ
authors: White
authors: Coagulation Advancement Laboratory, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA.
authors: D
authors: D
authors: Contaifer
authors: Coagulation Advancement Laboratory, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA.
authors: E J
authors: EJ
authors: Martin
authors: Coagulation Advancement Laboratory, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA.
authors: J C
authors: JC
authors: Newton
authors: Coagulation Advancement Laboratory, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA.|Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
authors: B M
authors: BM
authors: Mohammed
authors: Coagulation Advancement Laboratory, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA.
authors: J L
authors: JL
authors: Bostic
authors: Pharmacotherapy and Outcomes Science and Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA.
authors: G M
authors: GM
authors: Brophy
authors: Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA.
authors: B D
authors: BD
authors: Spiess
authors: United States Army Medical Research and Materiel Command, Fort Detrick, MD, USA.
authors: A E
authors: AE
authors: Pusateri
authors: Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, USA.
authors: K R
authors: KR
authors: Ward
authors: Coagulation Advancement Laboratory, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA.
authors: D F
authors: DF
authors: Brophy
mesh_terms: D000328:Adult; D001499:Bayes Theorem; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D016002:Discriminant Analysis; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis; D006487:Hemostasis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015539:Platelet Activation; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D013917:Thrombin / Q000378:metabolism; D013997:Time Factors; D014193:Trauma Centers; D014481:United States; D014504:Urban Health; D014947:Wounds and Injuries / Q000097:blood* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D005340:Fibrinogen; D013917:Thrombin
keywords: coagulation; fibrinogen; hemostasis; platelets; thrombin; trauma