Factors Associated with the Development of Coagulopathy after Open Traumatic Brain Injury

Abstract

Background: The incidence of coagulopathy after open traumatic brain injury (TBI) is high. Coagulopathy can aggravate intracranial hemorrhage and further increase morbidity and mortality. The purpose of this study was to determine the clinical characteristics of coagulopathy after open TBI and its relationship with the prognosis. Methods: This study retrospectively evaluated patients with isolated open TBI from December 2018 to December 2020. Coagulopathy was defined as international normalized ratio (INR) > 1.2, activated thromboplastin time (APTT) > 35 s, or platelet count <100,000/μL. We compared the relationship between the clinical, radiological, and laboratory parameters of patients with and without coagulopathy, and the outcome at discharge. Logistic regression analysis was used to evaluate the risk factors associated with coagulopathy. We then compared the effects of treatment with and without TXA in open TBI patients with coagulopathy. Results: A total of 132 patients were included in the study; 46 patients developed coagulopathy. Patients with coagulopathy had significantly lower platelet levels (170.5 × 109/L vs. 216.5 × 109/L, p < 0.001), and significantly higher INR (1.14 vs. 1.02, p < 0.001) and APTT (30.5 s vs. 24.5 s, p < 0.001) compared to those with no coagulopathy. A Low Glasgow Coma Scale (GCS) score, high neutrophil/lymphocyte ratio (NLR), low platelet/lymphocyte ratio (PLR), and hyperglycemia at admission were significantly associated with the occurrence of coagulopathy. Conclusions: Coagulopathy often occurs after open TBI. Patients with a low GCS score, high NLR, low PLR, and hyperglycemia at admission are at greater risk of coagulopathy, and therefore of poor prognosis. The efficacy of TXA in open TBI patients with coagulopathy is unclear. In addition, these findings demonstrate that PLR may be a novel indicator for predicting coagulopathy.

Neutrophil to Lymphocyte Ratio as a Predictor of Postoperative Outcomes in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

“…The studies were assessed with appropriate guidelines to characterize their quality based on several criteria ( Table 1 ) [ 8 , 17 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. NOS scores of 7–9 were deemed sufficient for the study as it fell in the region of “high quality” study according to the NOS guidelines, including case-control studies.…”

Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

“…Systemic inflammatory markers such as NLR, PWR, and PLR are new prognostic indicators in neurological disorders. 19 , 20 To our knowledge, this study is the first to explore the impact of these inflammation markers on the development of ABS associated with ASDH. The multivariate analysis revealed that low PWR on admission was an independent risk factor for post-traumatic ABS.…”

The prognostic values of neutrophil to lymphocyte ratio in traumatically injured patients upon admission: A mini-Review

“…Considerably, TBI patients with coagulopathy have more severe brain injuries and vigorous inflammatory reactions than those without coagulopathy signs. 41 Therefore, Alexiou et al introduced the value of NLR as a predictive biomarker for coagulopathy in TBI patients with a cut-off value of 4.2. 42 Lattanzi et al also demonstrated that higher levels of NLR in patients with spontaneous intracerebral hemorrhage within 24 h from onset were independently accompanied with more 30 days mortality and morbidity.…”