title: Evaluation of clotting factor activities early after severe multiple trauma and their correlation with coagulation tests and clinical data.
abstract: BACKGROUND
  Traumatic injuries are amongst the leading causes of death worldwide, frequently as a result of uncontrolled hemorrhage. Critical deficiencies in clotting factors have been noted in trauma-induced coagulopathy. However, the exact underlying conditions that result in devastating coagulopathies remain unclear. The purpose of this study was to elucidate these underlying deficiencies.
  
  
  METHODS
  Blood samples were drawn from 45 severely injured trauma patients on their arrival at the resuscitation room, and the activities of all soluble clotting factors and routine coagulation tests were assessed. The Mann-Whitney-U-test was used to assess differences in coagulation activity between the patients and healthy controls. Furthermore, Spearman's rank correlation was used to analyze the blood work.
  
  
  RESULTS
  After severe trauma the levels of serum fibrinogen and calcium were significantly reduced. Furthermore, traumatized patients had a significantly increased International Normalized Ratio (INR) compared to healthy controls. The median activities of all clotting factors were reduced after severe multiple trauma, with the exception of factor VIII, which was increased. Statistically significant differences were observed for factors II (80 vs. 122 %, P < 0.0001), V (76 vs. 123 %, P < 0.0001), VII (90 vs. 114 %, P = 0.002), VIII (200 vs. 108 %, P < 0.0001), and X (86 vs. 122 %, P < 0.0001). Spearman's correlation indicated a significant negative correlation between INR on arrival with fibrinogen and levels of factors II, V, and VII, whereas Partial Thromboplastin Time was significantly negatively correlated with factor VIII (all P < 0.0001).
  
  
  CONCLUSIONS
  These findings suggest a general but rather moderate impairment of clotting factor activities following severe multiple trauma. In the concept of a calculated coagulation therapy, this could demand for the use of factor concentrates with higher ratios of clotting factors. Finally, the physiological importance of strongly elevated factor VIII activity remains unclear, but a possible interference with ex vivo measurements of Partial Thromboplastin Time has to be considered.
authors.affiliation: Department for Orthopaedics and Emergency Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Burggraf
authors.affiliation: Department for Orthopaedics and Emergency Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Arzu
authors.initials: A
authors.lastname: Payas
authors.affiliation: Department for Orthopaedics and Emergency Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
authors.forename: Max Daniel
authors.initials: MD
authors.lastname: Kauther
authors.affiliation: Clinic for Accident Surgery and Orthopaedics, Alfried Krupp Hospital Steele, Hellweg 100, 45276 Essen, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schoeneberg
authors.affiliation: Clinic for Accident Surgery and Orthopaedics, Alfried Krupp Hospital Steele, Hellweg 100, 45276 Essen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Lendemans
keywords: Clotting factor; Coagulation; Coagulation factor; Coagulopathy; Injury; International normalized ratio; Partial thromboplastin time; Severe multiple trauma