Risk Factors and Neurologic Outcomes in Patients with Traumatic Brain Injury and Coagulopathy Within 72 h After Surgery

Abstract

Tao Chang,1,* Xigang Yan,2,* Chao Zhao,3,* Yufu Zhang,4 Bao Wang,4 Li Gao4 1Department of Emergency, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China; 2Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China; 3Department of Neurology, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China; 4Department of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Li GaoDepartment of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University, No. 1, Xinsi Road, Xi’an, 710038, Shaanxi Province, People’s Republic of ChinaTel [phone]Email [email protected]: The purpose of this study was to explore the effect of coagulopathy in patients with traumatic brain injury (TBI) during the early postoperative period.Methods: The baseline characteristics, intraoperative management, and follow-up data of 462 patients with TBI between January 2015 and June 2019 were collected and retrospectively analyzed by multivariate logistic regression. Coagulopathy was defined as activated partial thromboplastin time > 40 s, international normalized ratio > 1.4, or platelet counts < 100× 109/L.Results: Multivariate logistic regression analysis revealed that the Glasgow Coma Scale (GCS) on admission, Injury Severity Score (ISS) on admission, pupil mydriasis, duration of surgery, intraoperative blood loss, and intraoperative crystalloid resuscitation were independent risk factors for patients who developed coagulopathy after surgery. There were statistical differences in mortality (p = 0.049), the Glasgow Outcome Scale-Extended (GCS-E; p = 0.024), and the modified Rankin Scale (p = 0.043) between the patients with and without coagulopathy 1 week after surgery. Coagulopathy within 72 h after surgery revealed the higher mortality at 1 week (66.7%), 3 months (71.4%), and 6 months (76.2%). Coagulopathy within 72 h after surgery in patients with a TBI predicted worse disease progression and unfavorable neurologic outcomes.Conclusion: Taking practical and reasonable measures to manage these risk factors may protect patients with TBI from postoperative coagulopathy.Keywords: traumatic brain injury, postoperative coagulopathy, surgery, risk factor, mortality

Keywords

• traumatic brain injury
• postoperative coagulopathy
• surgery
• risk factor
• mortality