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Background <p>Polytrauma is associated with a high mortality rate and often accompanied by coagulopathy. Prothrombin time (PT) is a prognostic factor for mortality in polytrauma patients.</p> <p>The aim was to analyze the time- and severity-dependent role of PT in polytrauma patients related to mortality.</p> Methods <p>Patients (≥ 16&#xa0;years) with an Injury Severity Score ≥ 16 were retrospectively included, yielding 2890 cases after exclusion criteria. PT was measured at admission and 1, 2, 3, 4, 6, 8, 12, 24, and 48&#xa0;h thereafter, reported as percentage activity of the reference reagence [%].</p> <p>According to survival status, two groups were formed and compared. Binary logistic regression was used to test PT as an independent predictor for mortality. A closest top-left threshold method served for calculating threshold values between the survivor and non-survivor group. Patients were divided into subgroups according to PT levels and mortality was assessed for each subgroup at each time point.</p> Results <p>PT values in the non-survivor group were lower throughout the measuring period (<i>p</i> &lt; 0.05). PT threshold values declined from admission until 2&#xa0;h afterwards, reaching less than 50%. Already a slightly compromised PT (≤ 70%) represented a significant factor (<i>p</i> &lt; 0.05) for mortality at early and late time points, associated with a rate of more than 20%. In extremis, PT values of ≤ 25% were related to a mortality rate of more than 50% up to four hours after admission.</p> Conclusion <p>There are early and significant differences in mortality according to PT values in polytrauma patients (despite resuscitation measures), urging for a fast correction of PT. Time-dependent and stratified referencing may help clinicians estimate the mortality risk and decide upon the extent of surgical care.</p>

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Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月2日

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  • Philipp Vetter,
  • Cédric Niggli,
  • Jan Hambrecht,
  • Daniel Haschtmann,
  • Hans-Christoph Pape,
  • Ladislav Mica

摘要

Background

Polytrauma is associated with a high mortality rate and often accompanied by coagulopathy. Prothrombin time (PT) is a prognostic factor for mortality in polytrauma patients.

The aim was to analyze the time- and severity-dependent role of PT in polytrauma patients related to mortality.

Methods

Patients (≥ 16 years) with an Injury Severity Score ≥ 16 were retrospectively included, yielding 2890 cases after exclusion criteria. PT was measured at admission and 1, 2, 3, 4, 6, 8, 12, 24, and 48 h thereafter, reported as percentage activity of the reference reagence [%].

According to survival status, two groups were formed and compared. Binary logistic regression was used to test PT as an independent predictor for mortality. A closest top-left threshold method served for calculating threshold values between the survivor and non-survivor group. Patients were divided into subgroups according to PT levels and mortality was assessed for each subgroup at each time point.

Results

PT values in the non-survivor group were lower throughout the measuring period (p < 0.05). PT threshold values declined from admission until 2 h afterwards, reaching less than 50%. Already a slightly compromised PT (≤ 70%) represented a significant factor (p < 0.05) for mortality at early and late time points, associated with a rate of more than 20%. In extremis, PT values of ≤ 25% were related to a mortality rate of more than 50% up to four hours after admission.

Conclusion

There are early and significant differences in mortality according to PT values in polytrauma patients (despite resuscitation measures), urging for a fast correction of PT. Time-dependent and stratified referencing may help clinicians estimate the mortality risk and decide upon the extent of surgical care.